Provider Demographics
NPI:1750504486
Name:CAREDENT PLLC
Entity Type:Organization
Organization Name:CAREDENT PLLC
Other - Org Name:VILLAGE PLACE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-264-5410
Mailing Address - Street 1:6213 CHICAGO RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1610
Mailing Address - Country:US
Mailing Address - Phone:586-264-5410
Mailing Address - Fax:586-264-1119
Practice Address - Street 1:6213 CHICAGO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1610
Practice Address - Country:US
Practice Address - Phone:586-264-5410
Practice Address - Fax:586-264-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty