Provider Demographics
NPI:1649369356
Name:PEDIATRIC DENTAL CENTER
Entity type:Organization
Organization Name:PEDIATRIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ORIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDSMS
Authorized Official - Phone:586-754-6300
Mailing Address - Street 1:11662 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4588
Mailing Address - Country:US
Mailing Address - Phone:586-754-6300
Mailing Address - Fax:586-754-6407
Practice Address - Street 1:11662 MARTIN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4588
Practice Address - Country:US
Practice Address - Phone:586-754-6300
Practice Address - Fax:586-754-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI154631223P0221X
MI104661223P0221X
MI080561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty