Provider Demographics
NPI:1871959445
Name:ANN ARBOR FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:ANN ARBOR FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-971-2980
Mailing Address - Street 1:2755 CARPENTER RD
Mailing Address - Street 2:SUITE 1 NE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1186
Mailing Address - Country:US
Mailing Address - Phone:734-971-2980
Mailing Address - Fax:
Practice Address - Street 1:2755 CARPENTER RD
Practice Address - Street 2:SUITE 1 NE
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1186
Practice Address - Country:US
Practice Address - Phone:734-971-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty