Provider Demographics
NPI:1871187195
Name:TRU DENTAL MICHIGAN PC
Entity Type:Organization
Organization Name:TRU DENTAL MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:4925 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2027
Mailing Address - Country:US
Mailing Address - Phone:313-291-4970
Mailing Address - Fax:313-291-4970
Practice Address - Street 1:4925 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2027
Practice Address - Country:US
Practice Address - Phone:313-291-4970
Practice Address - Fax:313-291-4970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRU DENTAL MICHIGAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty