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General NPI Number Information
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NPI Number | 1174838817
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Entity Type | Organization
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Legal Business Name | EDMORE FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 08/19/2010
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Provider Practice Location Address
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Address Line | 1315 E HOWARD CITY EDMORE RD
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City | EDMORE
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State | MI
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Zip | 48829-9737
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Country | US
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Telephone | 989-427-3430
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 E HOWARD CITY EDMORE RD
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City | EDMORE
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State | MI
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Zip | 48829-9737
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Country | US
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Telephone | 989-427-3430
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. KIRKWOOD EARL FABER
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Credential |
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Telephone | 989-427-3430
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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 |
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License Number State |
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