Provider Demographics
NPI:1821378621
Name:UNIVERSTIY ORTHODONTICS, P.C.
Entity Type:Organization
Organization Name:UNIVERSTIY ORTHODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS,FRCD(C),PHD
Authorized Official - Phone:734-429-5433
Mailing Address - Street 1:214 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1327
Mailing Address - Country:US
Mailing Address - Phone:734-429-5433
Mailing Address - Fax:734-429-5033
Practice Address - Street 1:214 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1327
Practice Address - Country:US
Practice Address - Phone:734-429-5433
Practice Address - Fax:734-429-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty