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General NPI Number Information
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NPI Number | 1245328129
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Entity Type | Organization
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Legal Business Name | COLDWATER DENTAL INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 750 W MAIN ST
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City | COLDWATER
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State | OH
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Zip | 45828-1611
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Country | US
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Telephone | 419-678-4806
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Fax | 419-678-0077
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Provider Business Mailing Address
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Address Line | PO BOX 68 750 W MAIN ST
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City | COLDWATER
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State | OH
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Zip | 45828-0068
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Country | US
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Telephone | 419-678-4806
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Fax | 419-678-0077
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J BRUNS
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Credential | DDS
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Telephone | 419-678-4806
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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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