Provider Demographics
NPI:1346545811
Name:TRINITY DENTAL PC
Entity Type:Organization
Organization Name:TRINITY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-893-2915
Mailing Address - Street 1:116 W COLBY ST
Mailing Address - Street 2:STE 1
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1083
Mailing Address - Country:US
Mailing Address - Phone:231-893-2915
Mailing Address - Fax:
Practice Address - Street 1:116 W COLBY ST
Practice Address - Street 2:STE 1
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1083
Practice Address - Country:US
Practice Address - Phone:231-893-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0194591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI019459OtherSTATE LICENSE