Provider Demographics
NPI:1912107400
Name:DENTAL HEALTH GROUP OF MICHIGAN
Entity Type:Organization
Organization Name:DENTAL HEALTH GROUP OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-652-6313
Mailing Address - Street 1:8890 W 8 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-4202
Mailing Address - Country:US
Mailing Address - Phone:313-369-1700
Mailing Address - Fax:313-369-2774
Practice Address - Street 1:8890 W 8 MILE RD
Practice Address - Street 2:STE A
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-4202
Practice Address - Country:US
Practice Address - Phone:313-369-1700
Practice Address - Fax:313-369-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty