Provider Demographics
NPI:1295110856
Name:TWELVE OAKS ORTHODONTICS PLLC
Entity type:Organization
Organization Name:TWELVE OAKS ORTHODONTICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:734-454-9200
Mailing Address - Street 1:44110 W 12 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2614
Mailing Address - Country:US
Mailing Address - Phone:248-306-9330
Mailing Address - Fax:
Practice Address - Street 1:44110 W 12 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2614
Practice Address - Country:US
Practice Address - Phone:248-306-9330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty