Provider Demographics
NPI:1639756240
Name:WEST BAY FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:WEST BAY FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:BRIGHAM
Authorized Official - Last Name:SORBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-388-0456
Mailing Address - Street 1:690 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9587
Mailing Address - Country:US
Mailing Address - Phone:231-271-4537
Mailing Address - Fax:
Practice Address - Street 1:690 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9587
Practice Address - Country:US
Practice Address - Phone:231-271-4537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty