Provider Demographics
NPI:1659852614
Name:MY FAMILY DENTAL TAYLOR, PLLC
Entity Type:Organization
Organization Name:MY FAMILY DENTAL TAYLOR, PLLC
Other - Org Name:MY FAMILY DENTAL TAYLOR, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE STAFF MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-295-2600
Mailing Address - Street 1:9310 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3362
Mailing Address - Country:US
Mailing Address - Phone:313-295-2600
Mailing Address - Fax:313-295-7927
Practice Address - Street 1:9310 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3362
Practice Address - Country:US
Practice Address - Phone:313-295-2600
Practice Address - Fax:313-295-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI222181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty