Provider Demographics
NPI:1629675020
Name:SUPERIOR FAMILY DENTAL
Entity Type:Organization
Organization Name:SUPERIOR FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-684-9555
Mailing Address - Street 1:425 W HURON ST STE 140
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-2243
Mailing Address - Country:US
Mailing Address - Phone:248-684-9555
Mailing Address - Fax:248-684-9777
Practice Address - Street 1:425 W HURON ST STE 140
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-2243
Practice Address - Country:US
Practice Address - Phone:248-684-9555
Practice Address - Fax:248-684-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty