Provider Demographics
NPI:1053923656
Name:FAMILY DENTISTRY OF FARMINGTON
Entity type:Organization
Organization Name:FAMILY DENTISTRY OF FARMINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER-REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-474-8060
Mailing Address - Street 1:24001 ORCHARD LAKE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24001 ORCHARD LAKE RD STE 160
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-2553
Practice Address - Country:US
Practice Address - Phone:248-474-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental