Provider Demographics
NPI:1942660857
Name:ARBOR DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ARBOR DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-553-9393
Mailing Address - Street 1:44170 W 12 MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2614
Mailing Address - Country:US
Mailing Address - Phone:248-553-9393
Mailing Address - Fax:248-553-7644
Practice Address - Street 1:44170 W 12 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2614
Practice Address - Country:US
Practice Address - Phone:248-553-9393
Practice Address - Fax:248-553-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019235122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7525000001Medicare NSC