Provider Demographics
NPI:1790145381
Name:GARDEN CITY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GARDEN CITY FAMILY DENTISTRY
Other - Org Name:FAMILY DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DELISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-522-6340
Mailing Address - Street 1:7110 VENOY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1637
Mailing Address - Country:US
Mailing Address - Phone:734-522-6340
Mailing Address - Fax:
Practice Address - Street 1:7110 VENOY RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1637
Practice Address - Country:US
Practice Address - Phone:734-522-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL ACQUISITIONS GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1972551810122300000X
MI14474098001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty