# AWESOME DENTAL

> 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
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912400128
- **Authorized official:** DR. MARK JOHN HALBOTH (DDS)
- **Authorized official phone:** (734) 464-3430

## Contact information

- **Practice address:** 36000 FIVE MILE RD, LIVONIA, MI 48154-1918
- **Practice address phone:** (734) 464-3430
- **Practice address fax:** (734) 464-6206
- **Mailing address:** 36000 FIVE MILE RD, LIVONIA, MI 48154-1918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 13751 | MI | Yes |

## Other

- **Enumeration date:** 03/14/2018
- **Last updated:** 03/14/2018