MEDICARE: KARIN L GIFFORD DMD

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	1223G0001X	General Practice Dentistry	18005	MI

General Provider Information

NPI Number	:	1386843100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN L GIFFORD DMD

Provider Business Mailing Address
First Line	:	1903 EVANS ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4459
Country	:	US
Telephone Number	:	989-772-3216
Fax Number	:	989-773-4776

Provider Business Practice Location Address
First Line	:	1903 EVANS ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4459
Country	:	US
Telephone Number	:	989-772-3216
Fax Number	:	989-773-4776

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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