Organization
LATHRUP FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MASON HADDOW (PRESIDENT/DENTIST)
(248) 569-2056
Entity
Organization
Contact information
Practice address
28625 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-2701
(248) 569-2056
(248) 569-8987
Mailing address
28625 SOUTHFIELD RD, LATHRUP VILLAGE, MI 48076-2701
(248) 569-8987
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14801
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1842223
—
MI
Enumeration date
05/07/2008
Last updated
05/07/2008
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