Provider Demographics
NPI:1942627450
Name:ADVANCED PERIODONTICS IMPLANTOLOGY
Entity Type:Organization
Organization Name:ADVANCED PERIODONTICS IMPLANTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-546-0022
Mailing Address - Street 1:26789 WOODWARD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1335
Mailing Address - Country:US
Mailing Address - Phone:248-546-0022
Mailing Address - Fax:248-546-6811
Practice Address - Street 1:26789 WOODWARD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1335
Practice Address - Country:US
Practice Address - Phone:248-546-0022
Practice Address - Fax:248-546-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty