Healthcare Provider Details

I. General information

NPI: 1881869576
Provider Name (Legal Business Name): BIRCH RUN FAMILY DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 BIRCH RUN RD
BIRCH RUN MI
48415-9442
US

IV. Provider business mailing address

9420 BIRCH RUN RD
BIRCH RUN MI
48415-9442
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-5570
  • Fax: 989-624-5576
Mailing address:
  • Phone: 989-624-5570
  • Fax: 989-624-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL C DANEK
Title or Position: DENTIST
Credential: DDS
Phone: 989-624-5570