Provider Demographics
NPI:1003022005
Name:CHEBOYGAN DENTAL ASSOCIATES INC
Entity Type:Organization
Organization Name:CHEBOYGAN DENTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-627-9181
Mailing Address - Street 1:128 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721
Mailing Address - Country:US
Mailing Address - Phone:231-627-9181
Mailing Address - Fax:231-627-2152
Practice Address - Street 1:128 S HURON STREET
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721
Practice Address - Country:US
Practice Address - Phone:231-627-9181
Practice Address - Fax:231-627-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty