Provider Demographics
NPI:1407915846
Name:FRANKENMUTH FAMILY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:FRANKENMUTH FAMILY DENTAL ASSOCIATES
Other - Org Name:PIESKO & LENNAN DDS, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIERLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-652-6196
Mailing Address - Street 1:1025 W GENESEE ST
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1302
Mailing Address - Country:US
Mailing Address - Phone:989-652-6196
Mailing Address - Fax:989-652-9021
Practice Address - Street 1:15741 GRATIOT ROAD
Practice Address - Street 2:
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-9463
Practice Address - Country:US
Practice Address - Phone:989-642-2750
Practice Address - Fax:989-652-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1613822OtherUNITED CONCORDIA
MI510091OtherUNITED CONCORDIA
MI1613756OtherUNITED CONCORDIA
MI1847794OtherUNITED CONCORDIA
MI422881OtherUNITED CONCORDIA
MI470274OtherUNITED CONCORDIA