Organization
CASEVILLE FAMILY DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY REDWANTZ (MANAGER)
(989) 856-4096
Entity
Organization
Contact information
Practice address
6982 MAIN ST, CASEVILLE, MI 48725-5110
(989) 856-4096
(989) 856-4025
Mailing address
PO BOX 279, CASEVILLE, MI 48725-0279
(989) 856-4096
(989) 856-4025
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15627
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15627
STATE DENTAL LICENSE
MI
Enumeration date
06/19/2017
Last updated
06/19/2017
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