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Organization
OLD MISSION PENINSULA DENTISTRY RC
Active
Organization
OLD MISSION PENINSULA DENTISTRY RC
Active
Other names
Old Mission Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA AYLWORTH (OWNER)
(231) 223-4232
Entity
Organization
Contact information
Practice address
3258 BOWERS HARBOR RD, TRAVERSE CITY, MI 49686-9737
(231) 223-4232
(231) 223-9205
Mailing address
3258 BOWERS HARBOR RD, TRAVERSE CITY, MI 49686-9737
(231) 223-4232
(231) 223-9205
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901019846
MI
Other
Enumeration date
03/23/2016
Last updated
03/28/2016
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