Provider Demographics
NPI:1760689350
Name:ALMONT DENTAL CENTRE, P.C.
Entity Type:Organization
Organization Name:ALMONT DENTAL CENTRE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDDERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-798-8585
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:606 N. MAIN
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-0465
Mailing Address - Country:US
Mailing Address - Phone:810-798-8585
Mailing Address - Fax:
Practice Address - Street 1:606 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:MI
Practice Address - Zip Code:48003-8553
Practice Address - Country:US
Practice Address - Phone:810-798-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI193991223G0001X
MI144811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962502237OtherDENTIST
MI1245342435OtherDENTIST