Provider Demographics
NPI:1295902302
Name:DISTINCTIVE DENTAL
Entity type:Organization
Organization Name:DISTINCTIVE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-207-6013
Mailing Address - Street 1:58047 VAN DYKE RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48094-4000
Mailing Address - Country:US
Mailing Address - Phone:586-207-6013
Mailing Address - Fax:586-207-6300
Practice Address - Street 1:58047 VAN DYKE RD
Practice Address - Street 2:SUITE #101
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48094-4000
Practice Address - Country:US
Practice Address - Phone:586-207-6013
Practice Address - Fax:586-207-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty