Healthcare Provider Details

I. General information

NPI: 1376272476
Provider Name (Legal Business Name): ST. HELEN FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N SAINT HELEN RD
SAINT HELEN MI
48656-8543
US

IV. Provider business mailing address

PO BOX 9
SAINT HELEN MI
48656-0009
US

V. Phone/Fax

Practice location:
  • Phone: 989-389-4931
  • Fax: 989-389-3633
Mailing address:
  • Phone: 989-389-4931
  • Fax: 989-389-3633

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: JENNIFER TOZER
Title or Position: OFFICE MANAGER
Credential:
Phone: 989-389-4931