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General NPI Number Information
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NPI Number | 1760851794
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Entity Type | Organization
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Legal Business Name | RACINE & ACKLEY D.D.S., P.C.
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 573 W VIENNA ST
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City | CLIO
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State | MI
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Zip | 48420-5000
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Country | US
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Telephone | 810-686-5220
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Fax | 810-686-1620
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Provider Business Mailing Address
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Address Line | 573 W VIENNA ST
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City | CLIO
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State | MI
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Zip | 48420-5000
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Country | US
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Telephone | 810-686-5220
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Fax | 810-686-1620
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PAUL JOSEPH RACINE
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Credential | D.D.S.
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Telephone | 810-686-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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