Provider Demographics
NPI:1063802338
Name:MADISON HEIGHTS DENTAL CARE
Entity type:Organization
Organization Name:MADISON HEIGHTS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-569-6304
Mailing Address - Street 1:28755 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3005
Mailing Address - Country:US
Mailing Address - Phone:248-569-6305
Mailing Address - Fax:248-569-7914
Practice Address - Street 1:28755 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3005
Practice Address - Country:US
Practice Address - Phone:248-569-6305
Practice Address - Fax:248-569-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty