Healthcare Provider Details

I. General information

NPI: 1154558898
Provider Name (Legal Business Name): KITRIDGE ANDERSON, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2009
Last Update Date: 06/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 MICHIGAN AVE
ONAWAY MI
49765-8852
US

IV. Provider business mailing address

4080 MICHIGAN AVE
ONAWAY MI
49765-8852
US

V. Phone/Fax

Practice location:
  • Phone: 989-733-8533
  • Fax: 989-733-8533
Mailing address:
  • Phone: 989-733-8533
  • Fax: 989-733-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17375
License Number StateMI

VIII. Authorized Official

Name: DR. KITRIDGE GREGORY ANDERSON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 989-733-8533