Provider Demographics
NPI:1437172491
Name:MID MICHIGAN GENERAL DENTISTRY
Entity Type:Organization
Organization Name:MID MICHIGAN GENERAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-645-9980
Mailing Address - Street 1:400 S NELSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-8774
Mailing Address - Country:US
Mailing Address - Phone:517-645-9980
Mailing Address - Fax:517-645-9981
Practice Address - Street 1:400 S NELSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-8774
Practice Address - Country:US
Practice Address - Phone:517-645-9980
Practice Address - Fax:517-645-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010186151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty