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General NPI Number Information
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NPI Number | 1053731695
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Entity Type | Organization
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Legal Business Name | GARY A. SCHLUCKEBIER, DDS, PLLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 921 N PINE RIVER ST
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City | ITHACA
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State | MI
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Zip | 48847-1119
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Country | US
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Telephone | 989-875-4721
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Fax | 989-875-6018
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Provider Business Mailing Address
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Address Line | 921 N PINE RIVER ST
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City | ITHACA
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State | MI
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Zip | 48847-1119
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Country | US
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Telephone | 989-875-4721
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Fax | 989-875-6018
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. GARY SCHLUCKEBIER
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Credential | DDS
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Telephone | 989-875-4721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 016837
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License Number State | MI
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