Provider Demographics
NPI:1790021442
Name:ABC DENTAL PC
Entity Type:Organization
Organization Name:ABC DENTAL PC
Other - Org Name:COMFORT DENTAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIMANKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-996-9966
Mailing Address - Street 1:760 W EISENHOWER PKWY
Mailing Address - Street 2:SUITE #310
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5890
Mailing Address - Country:US
Mailing Address - Phone:734-996-9966
Mailing Address - Fax:
Practice Address - Street 1:760 W EISENHOWER PKWY
Practice Address - Street 2:SUITE #310
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5890
Practice Address - Country:US
Practice Address - Phone:734-996-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17664122300000X
MI16459122300000X
MI20572122300000X
MI18228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty