MEDICARE: PROGRESSIVE DENTAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	18449	MI

General Provider Information

NPI Number	:	1033443817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE DENTAL CARE

Provider Business Mailing Address
First Line	:	112 EAST MAIN STRREET
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712
Country	:	US
Telephone Number	:	231-582-6944
Fax Number	:	231-582-6978

Provider Business Practice Location Address
First Line	:	112 EAST MAIN STRREET
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712-1336
Country	:	US
Telephone Number	:	231-582-6944
Fax Number	:	231-582-6978

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIELLE J SWARTZ
Credential	:	DDS
Telephone Number	:	231-582-6944

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/25/2009

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Directions to “PROGRESSIVE DENTAL CARE ” Practice Location

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