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General NPI Number Information
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NPI Number | 1972311355
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Entity Type | Organization
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Legal Business Name | FIRST CLASS FAMILY DENTISTRY C
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 30 DAWSON ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1032
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Country | US
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Telephone | 586-800-7626
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Fax |
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Provider Business Mailing Address
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Address Line | 30 DAWSON ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1032
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. RA LONG
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Credential |
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Telephone | 586-500-7626
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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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