Provider Demographics
NPI:1851870265
Name:AO OF NOVI, PLLC
Entity Type:Organization
Organization Name:AO OF NOVI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SABOURIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-792-8315
Mailing Address - Street 1:24520 MEADOWBROOK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2866
Mailing Address - Country:US
Mailing Address - Phone:989-792-8315
Mailing Address - Fax:
Practice Address - Street 1:24520 MEADOWBROOK RD STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2866
Practice Address - Country:US
Practice Address - Phone:989-792-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI182611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty