Healthcare Provider Details

I. General information

NPI: 1033963111
Provider Name (Legal Business Name): OGEMAW FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N 5TH ST
WEST BRANCH MI
48661-1005
US

IV. Provider business mailing address

203 N 5TH ST
WEST BRANCH MI
48661-1005
US

V. Phone/Fax

Practice location:
  • Phone: 989-312-3110
  • Fax:
Mailing address:
  • Phone: 989-312-3110
  • Fax:

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. MARY BACHELDER
Title or Position: DENTIST
Credential: DDS
Phone: 517-898-7522