Provider Demographics
NPI:1235375296
Name:FLAT RRIVER FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:FLAT RRIVER FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR PERSON
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:E
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-754-3511
Mailing Address - Street 1:124 W. CASS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838
Mailing Address - Country:US
Mailing Address - Phone:616-754-3511
Mailing Address - Fax:606-754-2222
Practice Address - Street 1:400 W OAK ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2276
Practice Address - Country:US
Practice Address - Phone:616-754-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10419122300000X
MI29010104191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty