Organization
TOOTH TIME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOLLIE M BLACK RDH (DIRECTOR)
(269) 731-4581
Entity
Organization
Contact information
Practice address
7057 STONEY CREEK DR, AUGUSTA, MI 49012-8883
(269) 731-4581
Mailing address
7057 STONEY CREEK DR, AUGUSTA, MI 49012-8883
(269) 731-4581
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
2901017274
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4915898
—
MI
Enumeration date
10/06/2006
Last updated
08/22/2020
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