Provider Demographics
NPI:1306022462
Name:BAY CITY DENTAL CLINIC
Entity Type:Organization
Organization Name:BAY CITY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-7062
Mailing Address - Street 1:1411 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6109
Mailing Address - Country:US
Mailing Address - Phone:989-892-7062
Mailing Address - Fax:989-892-3561
Practice Address - Street 1:1411 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6109
Practice Address - Country:US
Practice Address - Phone:989-892-7062
Practice Address - Fax:989-892-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty