Provider Demographics
NPI:1326623075
Name:TRU DENTAL MICHIGAN PC
Entity Type:Organization
Organization Name:TRU DENTAL MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TABATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-6078
Mailing Address - Street 1:105 HIGHLAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3266
Mailing Address - Country:US
Mailing Address - Phone:269-964-3957
Mailing Address - Fax:
Practice Address - Street 1:105 HIGHLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3266
Practice Address - Country:US
Practice Address - Phone:269-964-3957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRU DENTAL MICHIGAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty