Provider Demographics
NPI:1083263701
Name:THIRD COAST DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:THIRD COAST DENTAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FRANKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-352-9221
Mailing Address - Street 1:2266 FRANKFORT HWY, P.O. BOX 793
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635
Mailing Address - Country:US
Mailing Address - Phone:231-352-9241
Mailing Address - Fax:231-352-9241
Practice Address - Street 1:2266 FRANKFORT HWY
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635
Practice Address - Country:US
Practice Address - Phone:231-352-9241
Practice Address - Fax:231-352-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty