Healthcare Provider Details

I. General information

NPI: 1144301946
Provider Name (Legal Business Name): ADULT AND PEDIATRIC DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GRAND ST
COLDWATER MI
49036-1621
US

IV. Provider business mailing address

50 GRAND ST
COLDWATER MI
49036-1621
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-8289
  • Fax: 517-278-5742
Mailing address:
  • Phone: 517-278-8289
  • Fax: 517-278-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MATTHEW PAUL KRUTSCH
Title or Position: OWNER
Credential: DDS
Phone: 517-278-8289