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General NPI Number Information
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NPI Number | 1245363837
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Entity Type | Organization
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Legal Business Name | MESICK DENTAL CENTER, PC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 5055 N M 37
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City | MESICK
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State | MI
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Zip | 49668-9705
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Country | US
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Telephone | 231-885-1711
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 489 5055 N M-37
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City | MESICK
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State | MI
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Zip | 49668-0489
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Country | US
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Telephone | 231-885-1711
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE E CAIN
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Credential | DDS
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Telephone | 231-885-1711
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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 | 2901016563
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License Number State | MI
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