Organization
SOUTHGATE ARDENT PLLC
Active
Other names
Northline Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA BURKEEN (MANAGER)
(734) 284-8088
Entity
Organization
Contact information
Practice address
13703 NORTHLINE RD, SOUTHGATE, MI 48195-1866
(734) 284-8088
(734) 284-0522
Mailing address
13703 NORTHLINE RD, SOUTHGATE, MI 48195-1866
(734) 284-8088
(734) 284-0522
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053768432
NPI
MI
01
—
1447822572
NPI
MI
Enumeration date
04/05/2022
Last updated
04/05/2022
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