Provider Demographics
NPI:1891765277
Name:CHABEN, MICHAEL R (D,D,S)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:CHABEN
Suffix:
Gender:M
Credentials:D,D,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10984 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3058
Mailing Address - Country:US
Mailing Address - Phone:734-522-5520
Mailing Address - Fax:734-522-5522
Practice Address - Street 1:10984 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3058
Practice Address - Country:US
Practice Address - Phone:734-522-5520
Practice Address - Fax:734-522-5522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010099751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice