Provider Demographics
NPI:1790851970
Name:METROPOLITAN DENTAL CENTER OF WATERFORD PC
Entity Type:Organization
Organization Name:METROPOLITAN DENTAL CENTER OF WATERFORD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:INGBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-674-0418
Mailing Address - Street 1:4664 W WALTON
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329
Mailing Address - Country:US
Mailing Address - Phone:248-674-0418
Mailing Address - Fax:248-674-4518
Practice Address - Street 1:4664 W WALTON
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329
Practice Address - Country:US
Practice Address - Phone:248-674-0418
Practice Address - Fax:248-674-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty