PROFESSIONAL DENTAL ASSOCIATES PC; NPI #1154592285

Contact Information

PROFESSIONAL DENTAL ASSOCIATES PC

888 MICHIGAN AVE
BALDWIN, MI 49304

Phone: 231-745-7231
Fax: 231-745-7246
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	General Practice	1223G0001X

Indicates primary specialty

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NPI Profile & details for PROFESSIONAL DENTAL ASSOCIATES PC

NPI Number 1154592285

LBN Legal business name PROFESSIONAL DENTAL ASSOCIATES PC

Authorized official KEVIN MATHEWSON - (DENTIST OWNER)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 03/17/2008

Last updated 03/17/2008 - About 18 years ago

Identifiers

MA	License #	19296
MI	License #	10102
MI	License #	16945
MI	Other	8012380	BCBS
MI	Other	2007556	UCCI

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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