Healthcare Provider Details

I. General information

NPI: 1083627095
Provider Name (Legal Business Name): PETER MARANA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E 7TH AVE
NORWAY MI
49870
US

IV. Provider business mailing address

711 E 7TH AVE BOX 67
NORWAY MI
49870
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-5512
  • Fax: 906-563-7434
Mailing address:
  • Phone: 906-563-5512
  • Fax: 906-563-7434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14436
License Number StateMI

VIII. Authorized Official

Name: MRS. KATHLEEN JEAN MARANA
Title or Position: OFFICE MANAGER
Credential:
Phone: 906-563-5512