Provider Demographics
NPI:1467674911
Name:ANDOVER DENTAL PLC
Entity Type:Organization
Organization Name:ANDOVER DENTAL PLC
Other - Org Name:STONEHOUSE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NAVETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-627-9393
Mailing Address - Street 1:850 S ORTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8872
Mailing Address - Country:US
Mailing Address - Phone:248-627-9393
Mailing Address - Fax:248-627-9392
Practice Address - Street 1:850 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8872
Practice Address - Country:US
Practice Address - Phone:248-627-9393
Practice Address - Fax:248-627-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI142381223G0001X
MI175191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty