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General NPI Number Information
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NPI Number | 1053405258
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Entity Type | Organization
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Legal Business Name | FERRIS STATE UNIVERSITY DENTAL HYGIENE CLINIC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 FERRIS DR VFS 202
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City | BIG RAPIDS
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State | MI
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Zip | 49307-2740
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Country | US
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Telephone | 231-591-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 200 FERRIS DR VFS 202
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City | BIG RAPIDS
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State | MI
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Zip | 49307-2740
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Country | US
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Telephone | 231-591-2260
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Fax |
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Authorized Official
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Title or Position | VP OF ADMIN & FINANCE
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Name | MR. RICHARD P DUFFETT
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Credential |
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Telephone | 231-591-2150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9436
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License Number State | MI
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