Provider Demographics
NPI:1396878039
Name:DEERHAVEN FAMILY DENTISTRY, P.L.C.
Entity type:Organization
Organization Name:DEERHAVEN FAMILY DENTISTRY, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIERGARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-929-3606
Mailing Address - Street 1:5217 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6985
Mailing Address - Country:US
Mailing Address - Phone:231-929-3606
Mailing Address - Fax:231-929-0610
Practice Address - Street 1:5217 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6985
Practice Address - Country:US
Practice Address - Phone:231-929-3606
Practice Address - Fax:231-929-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty