Provider Demographics
NPI:1801919287
Name:OAKLAND FAMILY DENTAL CARE, PLC
Entity type:Organization
Organization Name:OAKLAND FAMILY DENTAL CARE, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BANCUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-844-8438
Mailing Address - Street 1:7184 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3552
Mailing Address - Country:US
Mailing Address - Phone:734-844-8438
Mailing Address - Fax:
Practice Address - Street 1:7184 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3552
Practice Address - Country:US
Practice Address - Phone:734-844-8438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013245261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
264873OtherUNITED CONCORDIA INS
MID132450OtherBLUE CROSS BLUE SHIELD