Provider Demographics
NPI:1417066077
Name:CHARLEVOIX FAMILY DENTISTRY PLC
Entity Type:Organization
Organization Name:CHARLEVOIX FAMILY DENTISTRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:PARAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-547-1100
Mailing Address - Street 1:205 FERRY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720
Mailing Address - Country:US
Mailing Address - Phone:231-547-1100
Mailing Address - Fax:231-237-0170
Practice Address - Street 1:205 FERRY AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720
Practice Address - Country:US
Practice Address - Phone:231-547-1100
Practice Address - Fax:231-237-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010157521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty