Provider Demographics
NPI:1033963111
Name:OGEMAW FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:OGEMAW FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHELDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-898-7522
Mailing Address - Street 1:203 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1005
Mailing Address - Country:US
Mailing Address - Phone:989-312-3110
Mailing Address - Fax:
Practice Address - Street 1:203 N 5TH ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1005
Practice Address - Country:US
Practice Address - Phone:989-312-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881328763Medicaid