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Dental Providers Dentist

Provider NPI: 1205249653

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
100 W MAIN ST  STOCKBRIDGE, MI 49285-9483 US
Tel: 517-851-8008  Fax: 517-851-8836

Business Mailing Address:
100 W MAIN ST PO BOX 519 STOCKBRIDGE, MI 49285-9483 US
Tel: 517-851-8008  Fax: 517-851-8836

NPI Information:
NPI: 1205249653
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 122300000X





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