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General NPI Number Information
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NPI Number | 1336465277
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Entity Type | Organization
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Legal Business Name | A TO Z FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 120 W MARKET ST
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City | TROY
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State | IL
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Zip | 62294-1419
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Country | US
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Telephone | 618-667-6453
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Fax | 618-667-6173
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Provider Business Mailing Address
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Address Line | 120 W MARKET ST
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City | TROY
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State | IL
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Zip | 62294-1419
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Country | US
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Telephone | 618-667-6453
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Fax | 618-667-6173
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL TODD MASSIE
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Credential | DMD
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Telephone | 618-667-6453
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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 | 019024886
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License Number State | IL
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