Organization
PEDIATRIC DENTAL SPECILAIST, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KACEY A WOODWARD (RECEPTIONIST)
(810) 987-5040
Entity
Organization
Contact information
Practice address
1026 SUPERIOR ST, PORT HURON, MI 48060-3748
(810) 987-5040
(810) 987-9499
Mailing address
1026 SUPERIOR ST, PORT HURON, MI 48060-3748
(810) 987-5040
(810) 987-9499
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4032586
—
MI
Enumeration date
06/28/2022
Last updated
07/26/2022
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