Healthcare Provider Details

I. General information

NPI: 1376859173
Provider Name (Legal Business Name): MID-MICHIGAN DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N STATE ST
STANTON MI
48888-9702
US

IV. Provider business mailing address

615 N STATE ST
STANTON MI
48888-9702
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-5237
  • Fax: 989-831-3666
Mailing address:
  • Phone: 989-831-5237
  • Fax: 989-831-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA SELBY
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 989-831-3641