Provider Demographics
NPI:1700282241
Name:FAMILY DENTISTRY & ASSOC. OF BELLEVILLE P.C.
Entity Type:Organization
Organization Name:FAMILY DENTISTRY & ASSOC. OF BELLEVILLE P.C.
Other - Org Name:FAMILY DENTISTRY & ASSOC. OF BELLEVILLE P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-699-1808
Mailing Address - Street 1:11784 BELLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2457
Mailing Address - Country:US
Mailing Address - Phone:734-699-1808
Mailing Address - Fax:734-699-3599
Practice Address - Street 1:11784 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2457
Practice Address - Country:US
Practice Address - Phone:734-699-1808
Practice Address - Fax:734-699-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14786122300000X
MI2901021210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053412684OtherDENTIST
MI1346645603OtherDENTIST