Provider Demographics
NPI:1386843100
Name:GIFFORD, KARIN L (DMD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:L
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4459
Mailing Address - Country:US
Mailing Address - Phone:989-772-3216
Mailing Address - Fax:989-773-4776
Practice Address - Street 1:1903 EVANS ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4459
Practice Address - Country:US
Practice Address - Phone:989-772-3216
Practice Address - Fax:989-773-4776
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI180051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice