Provider Demographics
NPI:1669509816
Name:TOWN CENTER FAMILY DENTAL
Entity Type:Organization
Organization Name:TOWN CENTER FAMILY DENTAL
Other - Org Name:AINSWORTH VILLA LINDE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:V
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-733-1410
Mailing Address - Street 1:4500 TOWN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3435
Mailing Address - Country:US
Mailing Address - Phone:810-733-1410
Mailing Address - Fax:810-733-6535
Practice Address - Street 1:4500 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3435
Practice Address - Country:US
Practice Address - Phone:810-733-1410
Practice Address - Fax:810-733-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty