# ACCESS DENTAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093819344
- **Authorized official:** AMANDA HAGIE (OFFICE MANAGER)
- **Authorized official phone:** (231) 935-8461

## Contact information

- **Practice address:** 431 MUNSON AVE STE C, TRAVERSE CITY, MI 49686-3060
- **Practice address phone:** (231) 935-8461
- **Practice address fax:** (231) 935-8467
- **Mailing address:** 431 MUNSON AVE STE C, TRAVERSE CITY, MI 49686-3060
- **Mailing address phone:** (231) 935-8461
- **Mailing address fax:** (231) 935-8467

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 012813 | MI | — |
| 1223G0001X | General Practice Dentistry | 012865 | MI | — |
| 1223G0001X | General Practice Dentistry | 014902 | MI | Yes |

## Other

- **Enumeration date:** 09/08/2006
- **Last updated:** 12/29/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 823434 | UNITED CONCORDIA | PA |
| 01 | — | D802395 | BCBS OF MI | MI |
| 01 | — | D80295 | BCBS OF MS | MI |