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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