Healthcare Provider Details

I. General information

NPI: 1376087759
Provider Name (Legal Business Name): KALKASKA FAMILY DENTAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S CEDAR ST
KALKASKA MI
49646-9458
US

IV. Provider business mailing address

134 S CEDAR ST P.O. BOX 700
KALKASKA MI
49646-9458
US

V. Phone/Fax

Practice location:
  • Phone: 231-258-9611
  • Fax:
Mailing address:
  • Phone: 231-258-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11119
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number165460
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES ANDREW CAMPBELL
Title or Position: OWNER
Credential: D.D.S.
Phone: 231-258-9611