Provider Demographics
NPI:1417067158
Name:BANDEEN, EMILY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:P
Last Name:BANDEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:PALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4602 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7932
Mailing Address - Country:US
Mailing Address - Phone:269-963-4118
Mailing Address - Fax:269-963-4167
Practice Address - Street 1:4602 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7932
Practice Address - Country:US
Practice Address - Phone:269-963-4118
Practice Address - Fax:269-963-4167
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4911093Medicaid
MI4911119Medicaid