Organization
PLEV MID PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BERTOLLINI (PRM)
(866) 273-8204
Entity
Organization
Contact information
Practice address
1520 JOE MANN BLVD, MIDLAND, MI 48642-8902
(989) 486-2040
(989) 832-3974
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(315) 410-5531
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13084
MI
Other
Enumeration date
11/18/2015
Last updated
11/18/2015
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