Provider Demographics
NPI:1316048077
Name:FAMILY DENTAL CENTER OF LIVONIA, P.L.C.
Entity type:Organization
Organization Name:FAMILY DENTAL CENTER OF LIVONIA, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:TOBIN
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-427-9300
Mailing Address - Street 1:28701 PLYMOUTH ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2335
Mailing Address - Country:US
Mailing Address - Phone:734-427-9300
Mailing Address - Fax:734-427-1200
Practice Address - Street 1:28701 PLYMOUTH ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2335
Practice Address - Country:US
Practice Address - Phone:734-427-9300
Practice Address - Fax:734-427-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016783122300000X
MI2901017710122300000X
MI2901018923122300000X
MI2902006805124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Single Specialty