Provider Demographics
NPI:1437320520
Name:FIREBERG FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:FIREBERG FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER OF COURT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FIREBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-232-2920
Mailing Address - Street 1:2811 E COURT ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-4054
Mailing Address - Country:US
Mailing Address - Phone:810-232-2920
Mailing Address - Fax:810-232-1054
Practice Address - Street 1:2811 E COURT ST
Practice Address - Street 2:SUITE I
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-4054
Practice Address - Country:US
Practice Address - Phone:810-232-2920
Practice Address - Fax:810-232-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4347398Medicaid