Provider Demographics
NPI:1760586408
Name:SOUTHFIELD FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:SOUTHFIELD FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-569-6304
Mailing Address - Street 1:18800 WEST TEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2655
Mailing Address - Country:US
Mailing Address - Phone:248-569-6304
Mailing Address - Fax:248-569-7914
Practice Address - Street 1:18800 WEST TEN MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2655
Practice Address - Country:US
Practice Address - Phone:248-569-6304
Practice Address - Fax:248-569-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty