Healthcare Provider Details

I. General information

NPI: 1760851794
Provider Name (Legal Business Name): RACINE & ACKLEY D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 W VIENNA ST
CLIO MI
48420-5000
US

IV. Provider business mailing address

573 W VIENNA ST
CLIO MI
48420-5000
US

V. Phone/Fax

Practice location:
  • Phone: 810-686-5220
  • Fax: 810-686-1620
Mailing address:
  • Phone: 810-686-5220
  • Fax: 810-686-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL JOSEPH RACINE
Title or Position: DENTIST
Credential: D.D.S.
Phone: 810-686-5220