Provider Demographics
NPI:1336258136
Name:MARY ANN HARCHICK DDS PC
Entity type:Organization
Organization Name:MARY ANN HARCHICK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-682-2050
Mailing Address - Street 1:255 NORTH TELEGRAPH RD #210
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328
Mailing Address - Country:US
Mailing Address - Phone:248-682-2050
Mailing Address - Fax:248-682-2046
Practice Address - Street 1:255 NORTH TELEGRAPH RD #210
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328
Practice Address - Country:US
Practice Address - Phone:248-682-2050
Practice Address - Fax:248-682-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty