# SOUTHGATE ARDENT PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Northline Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225779325
- **Authorized official:** MS. LAURA BURKEEN (MANAGER)
- **Authorized official phone:** (734) 284-8088

## Contact information

- **Practice address:** 13703 NORTHLINE RD, SOUTHGATE, MI 48195-1866
- **Practice address phone:** (734) 284-8088
- **Practice address fax:** (734) 284-0522
- **Mailing address:** 13703 NORTHLINE RD, SOUTHGATE, MI 48195-1866
- **Mailing address phone:** (734) 284-8088
- **Mailing address fax:** (734) 284-0522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/05/2022
- **Last updated:** 04/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1053768432 | NPI | MI |
| 01 | — | 1447822572 | NPI | MI |