Provider Demographics
NPI:1497824155
Name:BIRCHTREE DENTAL CENTER
Entity Type:Organization
Organization Name:BIRCHTREE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-326-2010
Mailing Address - Street 1:38959 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-3250
Mailing Address - Country:US
Mailing Address - Phone:734-326-2010
Mailing Address - Fax:734-326-2625
Practice Address - Street 1:38959 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-3250
Practice Address - Country:US
Practice Address - Phone:734-326-2010
Practice Address - Fax:734-326-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI102431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty