Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2901020266 | MI |
Y | 1223X0400X | Orthodontists | 2901020266 | MI |
NPI | 1003255167 |
---|---|
Provider Name | Dr. Aaron Michael Havens |
First Address | Washington, MI 48095-2836 |
Second Address | Washington, MI 48095-2836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2013 |
Last Update Date | 21/06/2013 |