Provider Demographics
NPI:1093910077
Name:SANDUSKY DENTAL CARE, PLC
Entity Type:Organization
Organization Name:SANDUSKY DENTAL CARE, PLC
Other - Org Name:SANDSUKY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNACHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-648-4740
Mailing Address - Street 1:30 DAWSON ST
Mailing Address - Street 2:PO BOX 231
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1032
Mailing Address - Country:US
Mailing Address - Phone:810-648-4740
Mailing Address - Fax:810-648-4796
Practice Address - Street 1:30 DAWSON ST
Practice Address - Street 2:BOX 231
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1032
Practice Address - Country:US
Practice Address - Phone:810-648-4740
Practice Address - Fax:810-648-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty