Provider Demographics
NPI:1619355070
Name:MACOMB CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:MACOMB CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BATRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-697-5272
Mailing Address - Street 1:51299 ROMEO PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4114
Mailing Address - Country:US
Mailing Address - Phone:586-697-5272
Mailing Address - Fax:
Practice Address - Street 1:51299 ROMEO PLANK RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-4114
Practice Address - Country:US
Practice Address - Phone:586-697-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010187431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty