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General NPI Number Information
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NPI Number | 1164170577
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Entity Type | Organization
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Legal Business Name | HOLY FAMILY DENTAL CLINICS
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 2 E MAIN ST
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City | HARTFORD
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State | MI
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Zip | 49057-1120
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Country | US
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Telephone | 269-621-0011
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Fax | 269-308-3336
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Provider Business Mailing Address
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Address Line | 301 N CENTER ST
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City | HARTFORD
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State | MI
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Zip | 49057-1199
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Country | US
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Telephone | 269-621-0011
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Fax | 269-308-3336
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONNIE D BOUCHARD
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Credential | DO
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Telephone | 269-621-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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