Provider Demographics
NPI:1124706775
Name:PRIME DENTISTRY NOVI PLLC
Entity type:Organization
Organization Name:PRIME DENTISTRY NOVI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-722-1617
Mailing Address - Street 1:35100 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-3698
Mailing Address - Country:US
Mailing Address - Phone:734-722-1617
Mailing Address - Fax:734-722-5240
Practice Address - Street 1:24505 FAIRMOUNT DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1541
Practice Address - Country:US
Practice Address - Phone:734-722-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental