Provider Demographics
NPI:1245466911
Name:GOLDEN DENTAL PLANS OF MICHIGAN, INC.
Entity type:Organization
Organization Name:GOLDEN DENTAL PLANS OF MICHIGAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-573-8118
Mailing Address - Street 1:29377 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3475
Mailing Address - Country:US
Mailing Address - Phone:586-573-8118
Mailing Address - Fax:586-573-8720
Practice Address - Street 1:29377 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3475
Practice Address - Country:US
Practice Address - Phone:586-573-8118
Practice Address - Fax:586-573-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization