Organization
PROFESSIONAL DENTAL ASSOCIATES PC
Active
Parent organization
PROFESSIONAL DENTAL ASSOCIATES PC
Other names
Jensen Shroger Anderson PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROFESSIONAL DENTAL ASSOCIATES PC
Authorized official
DR. KEVIN T MATHEWSON DDS (DENTIST OWNER)
(231) 796-3571
Entity
Organization
Contact information
Practice address
888 MICHIGAN AVE, BALDWIN, MI 49304
(231) 745-7231
(231) 745-7246
Mailing address
PO BOX 152, 888 MICHIGAN AVE, BALDWIN, MI 49304
(231) 745-7231
(231) 745-7246
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10102
MI
1223G0001X
General Practice Dentistry
16945
MI
1223G0001X
General Practice Dentistry
19296
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007556
UCCI
MI
01
—
8012380
BCBS
MI
Enumeration date
03/17/2008
Last updated
03/17/2008
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