Provider Demographics
NPI:1760582670
Name:MARK R. MORIN, D.D.S., P.C.
Entity Type:Organization
Organization Name:MARK R. MORIN, D.D.S., P.C.
Other - Org Name:HI-TECH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-354-1555
Mailing Address - Street 1:19178 WEST TEN MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-354-1555
Mailing Address - Fax:248-354-3331
Practice Address - Street 1:19178 W. TEN MILE RD.
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-354-1555
Practice Address - Fax:248-354-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty