# LATHRUP FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235305301
- **Authorized official:** DR. MASON HADDOW (PRESIDENT/DENTIST)
- **Authorized official phone:** (248) 569-2056

## Contact information

- **Practice address:** 28625 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-2701
- **Practice address phone:** (248) 569-2056
- **Practice address fax:** (248) 569-8987
- **Mailing address:** 28625 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-2701
- **Mailing address fax:** (248) 569-8987

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 14801 | MI | Yes |

## Other

- **Enumeration date:** 05/07/2008
- **Last updated:** 05/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1842223 | — | MI |