Provider Demographics
NPI:1851763387
Name:PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC
Other - Org Name:DENTAL CARE OF MICHIGAN, GARDEN CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIB
Authorized Official - Middle Name:
Authorized Official - Last Name:HALABU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-397-1165
Mailing Address - Street 1:11 S MILL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1658 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2879
Practice Address - Country:US
Practice Address - Phone:724-698-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty