Provider Demographics
NPI:1134426513
Name:MICHIGAN DENTURES
Entity type:Organization
Organization Name:MICHIGAN DENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DEN EEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-398-1900
Mailing Address - Street 1:3684 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1002
Mailing Address - Country:US
Mailing Address - Phone:248-398-1900
Mailing Address - Fax:248-394-1919
Practice Address - Street 1:3684 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1002
Practice Address - Country:US
Practice Address - Phone:248-398-1900
Practice Address - Fax:248-394-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-20
Last Update Date:2011-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty