Provider Demographics
NPI:1528678687
Name:ELMWOOD PARK DENTAL
Entity type:Organization
Organization Name:ELMWOOD PARK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:313-567-6200
Mailing Address - Street 1:1547 E LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2958
Mailing Address - Country:US
Mailing Address - Phone:313-567-6200
Mailing Address - Fax:
Practice Address - Street 1:1547 E LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2958
Practice Address - Country:US
Practice Address - Phone:313-567-6200
Practice Address - Fax:313-567-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty