Provider Demographics
NPI:1538401575
Name:HERBERT J. ELFRING JR., D.D.S., P.C.
Entity type:Organization
Organization Name:HERBERT J. ELFRING JR., D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ANDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-442-0400
Mailing Address - Street 1:40255 GRAND RIVER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2149
Mailing Address - Country:US
Mailing Address - Phone:248-442-0400
Mailing Address - Fax:
Practice Address - Street 1:40255 GRAND RIVER AVE STE 200
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2149
Practice Address - Country:US
Practice Address - Phone:248-442-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457672669OtherDENTIST NPI
MI1053535914OtherDENTIST NPI
MI1184747412OtherDENTIST NPI