Provider Demographics
NPI:1700100088
Name:ADVANCED FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:ADVANCED FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TOWNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-459-3700
Mailing Address - Street 1:44644 ANN ARBOR RD W
Mailing Address - Street 2:SUITE F
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4093
Mailing Address - Country:US
Mailing Address - Phone:734-459-3700
Mailing Address - Fax:734-459-3510
Practice Address - Street 1:44644 ANN ARBOR RD W
Practice Address - Street 2:SUITE F
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4093
Practice Address - Country:US
Practice Address - Phone:734-459-3700
Practice Address - Fax:734-459-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010111411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty