Provider Demographics
NPI:1710023502
Name:GREAT EXPRESSIONS DENTAL CENTERS OF MASSACHUSETTS PC
Entity type:Organization
Organization Name:GREAT EXPRESSIONS DENTAL CENTERS OF MASSACHUSETTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-203-1100
Mailing Address - Street 1:300 E LONG LAKE RD
Mailing Address - Street 2:STE 311
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2374
Mailing Address - Country:US
Mailing Address - Phone:248-203-1100
Mailing Address - Fax:248-203-1112
Practice Address - Street 1:300 E LONG LAKE RD
Practice Address - Street 2:STE 311
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:HI
Practice Address - Zip Code:48304
Practice Address - Country:US
Practice Address - Phone:248-203-1100
Practice Address - Fax:248-203-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty