| Organization Name: | MICHIGAN DENTURES |
| NPI Number: | 1134426513 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EVERETT VAN DEN EEDEN (OWNER / GENERAL PARTNER) |
| Mailing Address: | 3684 W 11 Mile Rd Berkley |
| State: | MI US |
| Postal Code: | 480721002 |
| Phone Number: | 2483981900 |
| Fax Number: | 2483941919 |
| NPI Enumeration Date: | 02/20/2011 |
| NPI Last Update Date: | 02/20/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |