Provider Demographics
NPI:1023214921
Name:FORD, AARON C (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:C
Last Name:FORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-1178
Mailing Address - Country:US
Mailing Address - Phone:269-649-1495
Mailing Address - Fax:734-647-4024
Practice Address - Street 1:602 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-1178
Practice Address - Country:US
Practice Address - Phone:269-649-1495
Practice Address - Fax:734-647-4024
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019582122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist