Provider Demographics
NPI:1912953779
Name:NEWMAN FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:NEWMAN FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FONDAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-563-1860
Mailing Address - Street 1:3733 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3286
Mailing Address - Country:US
Mailing Address - Phone:313-563-1830
Mailing Address - Fax:313-563-1860
Practice Address - Street 1:3733 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3286
Practice Address - Country:US
Practice Address - Phone:313-563-1830
Practice Address - Fax:313-563-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental