Healthcare Provider Details

I. General information

NPI: 1386345551
Provider Name (Legal Business Name): STANDISH FAMILY DENTAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S MAIN ST
STANDISH MI
48658-2539
US

IV. Provider business mailing address

PO BOX 847
STANDISH MI
48658-0847
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-4090
  • Fax: 989-846-4160
Mailing address:
  • Phone: 989-846-4090
  • Fax: 989-846-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW R DWAN
Title or Position: OWNER
Credential:
Phone: 989-846-4090