Provider Demographics
NPI:1497878375
Name:WB DENTAL CENTERS P.C.
Entity Type:Organization
Organization Name:WB DENTAL CENTERS P.C.
Other - Org Name:WEST BLOOMFIELD DENTAL CENTER P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-669-6608
Mailing Address - Street 1:45055 COBBLESTONE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1395
Mailing Address - Country:US
Mailing Address - Phone:248-669-6608
Mailing Address - Fax:248-681-3610
Practice Address - Street 1:3435 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1315
Practice Address - Country:US
Practice Address - Phone:248-681-4660
Practice Address - Fax:248-681-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010183021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty