Healthcare Provider Details

I. General information

NPI: 1730705443
Provider Name (Legal Business Name): 119 BRIDGE DENTAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E BRIDGE ST
PORTLAND MI
48875-1434
US

IV. Provider business mailing address

119 E BRIDGE ST
PORTLAND MI
48875-1434
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-4511
  • Fax:
Mailing address:
  • Phone: 517-647-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMI SCHNEIDER
Title or Position: DENTIST
Credential: D.D.S
Phone: 517-647-4511