Provider Demographics
NPI:1083180046
Name:GRAND BLANC PEDIATRIC DENTISTRY PC
Entity Type:Organization
Organization Name:GRAND BLANC PEDIATRIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-660-3424
Mailing Address - Street 1:7227 FENTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8961
Mailing Address - Country:US
Mailing Address - Phone:810-694-2770
Mailing Address - Fax:
Practice Address - Street 1:7227 FENTON RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8961
Practice Address - Country:US
Practice Address - Phone:734-660-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty