Provider Demographics
NPI:1134851504
Name:AE DENTAL PLLC
Entity type:Organization
Organization Name:AE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:KNORR
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-242-5872
Mailing Address - Street 1:35888 EVANSTON LN
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-6515
Mailing Address - Country:US
Mailing Address - Phone:586-242-5872
Mailing Address - Fax:
Practice Address - Street 1:8379 DAVISON RD STE A
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2089
Practice Address - Country:US
Practice Address - Phone:810-653-7120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental