Provider Demographics
NPI:1194407460
Name:H2G DENTAL PLLC
Entity type:Organization
Organization Name:H2G DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE OPERATIONS, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-327-7095
Mailing Address - Street 1:PO BOX 773037
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-3037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50530 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4604
Practice Address - Country:US
Practice Address - Phone:734-495-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H2G DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty