Provider Demographics
NPI:1851959241
Name:HAVILAND, CATHERINE (DDS, MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:HAVILAND
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15441 WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1722
Mailing Address - Country:US
Mailing Address - Phone:919-923-7240
Mailing Address - Fax:
Practice Address - Street 1:25000 JOSEPH
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5709
Practice Address - Country:US
Practice Address - Phone:919-923-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315206395122300000X
MI2901600828122300000X
MI43015148791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist