Provider Demographics
NPI:1114152006
Name:GINGRICH DENTAL PC
Entity Type:Organization
Organization Name:GINGRICH DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:V
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:231-796-8715
Mailing Address - Street 1:106 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2206
Mailing Address - Country:US
Mailing Address - Phone:231-796-8715
Mailing Address - Fax:231-796-6300
Practice Address - Street 1:106 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2206
Practice Address - Country:US
Practice Address - Phone:231-796-8715
Practice Address - Fax:231-796-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI112970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty