Provider Demographics
NPI:1609591387
Name:FERNDALE DENTAL
Entity Type:Organization
Organization Name:FERNDALE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-545-6400
Mailing Address - Street 1:2241 HILTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1459
Mailing Address - Country:US
Mailing Address - Phone:248-545-6400
Mailing Address - Fax:248-545-8530
Practice Address - Street 1:2241 HILTON RD STE 1
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1459
Practice Address - Country:US
Practice Address - Phone:248-545-6400
Practice Address - Fax:248-545-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental