Provider Demographics
NPI:1720172141
Name:HURON DENTAL ASSOCIATES, P.L.L.C
Entity type:Organization
Organization Name:HURON DENTAL ASSOCIATES, P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:AN
Authorized Official - Last Name:HAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-383-6800
Mailing Address - Street 1:18757 HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48164-9357
Mailing Address - Country:US
Mailing Address - Phone:734-753-5000
Mailing Address - Fax:
Practice Address - Street 1:18757 HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:MI
Practice Address - Zip Code:48164-9357
Practice Address - Country:US
Practice Address - Phone:734-753-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD8001880OtherBCBS