Provider Demographics
NPI:1104920446
Name:SELECT DENTAL PC
Entity type:Organization
Organization Name:SELECT DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ABOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-790-7550
Mailing Address - Street 1:16128 15 MILE ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026
Mailing Address - Country:US
Mailing Address - Phone:586-790-7550
Mailing Address - Fax:586-790-7780
Practice Address - Street 1:16128 15 MILE ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026
Practice Address - Country:US
Practice Address - Phone:586-790-7550
Practice Address - Fax:586-790-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty