Provider Demographics
NPI:1619348471
Name:MICHIGAN DENTAL PROVIDERS, P.C.
Entity Type:Organization
Organization Name:MICHIGAN DENTAL PROVIDERS, P.C.
Other - Org Name:DENTALWORKS OF NORTHVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NITTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-755-0816
Mailing Address - Street 1:7160 DALLAS PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7111
Mailing Address - Country:US
Mailing Address - Phone:248-344-1913
Mailing Address - Fax:
Practice Address - Street 1:39833 TRADITIONS DR
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9498
Practice Address - Country:US
Practice Address - Phone:248-344-1913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTALONE PARTNERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty