Provider Demographics
NPI:1235755224
Name:HOUGHTON LAKE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HOUGHTON LAKE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-422-4099
Mailing Address - Street 1:9260 W LAKE CITY RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-8902
Mailing Address - Country:US
Mailing Address - Phone:989-422-4099
Mailing Address - Fax:989-422-3167
Practice Address - Street 1:9260 W LAKE CITY RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8902
Practice Address - Country:US
Practice Address - Phone:989-422-4099
Practice Address - Fax:989-422-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental