Provider Demographics
NPI:1336465277
Name:A TO Z FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:A TO Z FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-667-6453
Mailing Address - Street 1:120 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1419
Mailing Address - Country:US
Mailing Address - Phone:618-667-6453
Mailing Address - Fax:618-667-6173
Practice Address - Street 1:120 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-1419
Practice Address - Country:US
Practice Address - Phone:618-667-6453
Practice Address - Fax:618-667-6173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty