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General NPI Number Information
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NPI Number | 1437172491
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Entity Type | Organization
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Legal Business Name | MID MICHIGAN GENERAL DENTISTRY
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 S NELSON ST SUITE B
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City | POTTERVILLE
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State | MI
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Zip | 48876-8774
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Country | US
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Telephone | 517-645-9980
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Fax | 517-645-9981
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Provider Business Mailing Address
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Address Line | 400 S NELSON ST SUITE B
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City | POTTERVILLE
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State | MI
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Zip | 48876-8774
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Country | US
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Telephone | 517-645-9980
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Fax | 517-645-9981
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Authorized Official
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Title or Position | PARTNER
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Name | DR. KRISTIN MAU
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Credential | DDS
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Telephone | 517-645-9980
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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 | 2901018615
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License Number State | MI
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