MEDICARE: SAGINAW VALLEY ORTHODONTIC SPECIALISTS, P.C.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2901009039	MI

General Provider Information

NPI Number	:	1588747604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGINAW VALLEY ORTHODONTIC SPECIALISTS, P.C.

Provider Business Mailing Address
First Line	:	5355 COLONY DR N
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48638-7190
Country	:	US
Telephone Number	:	989-792-2837
Fax Number	:	989-792-2834

Provider Business Practice Location Address
First Line	:	5355 COLONY DR N
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48638-7190
Country	:	US
Telephone Number	:	989-792-2837
Fax Number	:	989-792-2834

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES WESLEY CAREY
Credential	:	D.D.S.,M.S.
Telephone Number	:	989-792-2837

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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