Healthcare Provider Details

I. General information

NPI: 1588747604
Provider Name (Legal Business Name): SAGINAW VALLEY ORTHODONTIC SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 COLONY DR N
SAGINAW MI
48638-7190
US

IV. Provider business mailing address

5355 COLONY DR N
SAGINAW MI
48638-7190
US

V. Phone/Fax

Practice location:
  • Phone: 989-792-2837
  • Fax: 989-792-2834
Mailing address:
  • Phone: 989-792-2837
  • Fax: 989-792-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901009039
License Number StateMI

VIII. Authorized Official

Name: DR. CHARLES WESLEY CAREY
Title or Position: PRESIDENT
Credential: D.D.S.,M.S.
Phone: 989-792-2837