Provider Demographics
NPI:1376230979
Name:BIG RAPIDS FAMILY DENTAL PLC
Entity Type:Organization
Organization Name:BIG RAPIDS FAMILY DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-634-0595
Mailing Address - Street 1:6173 GAELIC CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9608
Mailing Address - Country:US
Mailing Address - Phone:616-634-0595
Mailing Address - Fax:
Practice Address - Street 1:201 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1809
Practice Address - Country:US
Practice Address - Phone:231-796-4747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty