Provider Demographics
NPI:1972920478
Name:ADVANCED PERIODONTICS/IMPLANTOLOGY
Entity type:Organization
Organization Name:ADVANCED PERIODONTICS/IMPLANTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-459-4077
Mailing Address - Street 1:40400 ANN ARBOR RD E
Mailing Address - Street 2:SUITE 204A
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6615
Mailing Address - Country:US
Mailing Address - Phone:734-459-4077
Mailing Address - Fax:734-459-4084
Practice Address - Street 1:40400 ANN ARBOR RD E
Practice Address - Street 2:SUITE 204A
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6615
Practice Address - Country:US
Practice Address - Phone:734-459-4077
Practice Address - Fax:734-459-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty