Provider Demographics
NPI:1558975672
Name:MAX AND MANDY DENTAL, PC
Entity Type:Organization
Organization Name:MAX AND MANDY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DUNCAN
Authorized Official - Last Name:MCLAREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-645-6548
Mailing Address - Street 1:2792 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1932
Mailing Address - Country:US
Mailing Address - Phone:734-434-6170
Mailing Address - Fax:734-514-4584
Practice Address - Street 1:2792 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1932
Practice Address - Country:US
Practice Address - Phone:734-434-6170
Practice Address - Fax:734-514-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental