Organization Name: | ALPHA FAMILY DENTAL PC |
NPI Number: | 1083015317 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CAMILO MACHADO (OWNER/DENTIST) |
Mailing Address: | 31315 Harper Ave Saint Clair Shores |
State: | MI US |
Postal Code: | 480822453 |
Phone Number: | 5862933434 |
Fax Number: | 5862934460 |
NPI Enumeration Date: | 09/05/2014 |
NPI Last Update Date: | 09/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 20116 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |