Provider Demographics
NPI:1932383890
Name:T&C DENTAL PLLC
Entity type:Organization
Organization Name:T&C DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-553-9393
Mailing Address - Street 1:34405 W 12 MILE RD
Mailing Address - Street 2:STE 187
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3391
Mailing Address - Country:US
Mailing Address - Phone:248-553-9393
Mailing Address - Fax:248-553-7644
Practice Address - Street 1:34405 W 12 MILE RD
Practice Address - Street 2:STE 187
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3391
Practice Address - Country:US
Practice Address - Phone:248-553-9393
Practice Address - Fax:248-553-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI192351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty