Organization
CANTON ARDENT
Active
Other names
Hometown Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA BURKEEN (MANANGER)
(734) 657-3395
Entity
Organization
Contact information
Practice address
45650 FORD RD, CANTON, MI 48187-5432
(734) 999-3366
(734) 999-3368
Mailing address
45650 FORD RD, CANTON, MI 48187-5432
(734) 999-3366
(734) 999-3368
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053768432
SHARVIL SHAH
MI
01
—
1508985318
PARESH SHRIMANKAR
MI
01
—
1841553302
LENA MUSTAFA
MI
Enumeration date
09/18/2020
Last updated
09/18/2020
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