| Pediatric Dental Specilaist, P.c | |
|
1026 Superior St Port Huron MI 48060-3748 | |
| (810) 987-5040 | |
| (810) 987-9499 |
| Full Name | Pediatric Dental Specilaist, P.c |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1026 Superior St, Port Huron, Michigan |
| Authorized Official Name and Position | Kacey A Woodward (RECEPTIONIST) |
| Authorized Official Contact | 8109875040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Specilaist, P.c 1026 Superior St Port Huron MI 48060-3748 Ph: (810) 987-5040 | Pediatric Dental Specilaist, P.c 1026 Superior St Port Huron MI 48060-3748 Ph: (810) 987-5040 |
| NPI Number | 1255063244 |
|---|---|
| Provider Enumeration Date | 06/28/2022 |
| Last Update Date | 07/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255063244 | NPI | - | NPPES |
| 4032586 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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