Individual
RIDGE DOWNS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
45420 VAN DYKE AVE, UTICA, MI 48317-5676
(586) 997-9484
Mailing address
4680 LOCKWOOD DR, WASHINGTON, MI 48094-2624
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
1223G0001X
General Practice Dentistry
Primary
2901601435
MI
Other
Enumeration date
03/28/2018
Last updated
08/02/2022
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