Provider Demographics
NPI:1669107819
Name:FLINT FAMILY DENTISTRY
Entity type:Organization
Organization Name:FLINT FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANESHVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-720-0611
Mailing Address - Street 1:G3023 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1353
Mailing Address - Country:US
Mailing Address - Phone:810-720-0611
Mailing Address - Fax:810-720-0613
Practice Address - Street 1:G3023 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1353
Practice Address - Country:US
Practice Address - Phone:810-720-0611
Practice Address - Fax:810-720-0613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental