# FOWLERVILLE FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1841620655
- **Authorized official:** DR. BRIAN J PETERSBURG DDS (PRESIDENT)
- **Authorized official phone:** (517) 223-8545

## Contact information

- **Practice address:** 753 S GRAND AVE, FOWLERVILLE, MI 48836-7914
- **Practice address phone:** (517) 223-8545
- **Practice address fax:** (517) 223-8505
- **Mailing address:** 753 S GRAND AVE, FOWLERVILLE, MI 48836-7914
- **Mailing address phone:** (517) 223-8545
- **Mailing address fax:** (517) 223-8505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901010174 | MI | Yes |
| 122300000X | Dentist | 2901017224 | MI | — |
| 122300000X | Dentist | 2901020477 | MI | — |

## Other

- **Enumeration date:** 11/14/2013
- **Last updated:** 11/14/2013