Provider Demographics
NPI:1437428448
Name:CEDAR POINT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CEDAR POINT FAMILY DENTISTRY
Other - Org Name:SANILAC FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-648-3224
Mailing Address - Street 1:749 N SANDUSKY RD
Mailing Address - Street 2:P.O. BOX 126
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-9143
Mailing Address - Country:US
Mailing Address - Phone:810-648-3224
Mailing Address - Fax:866-941-4892
Practice Address - Street 1:749 N SANDUSKY RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-9143
Practice Address - Country:US
Practice Address - Phone:810-648-3224
Practice Address - Fax:866-941-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI178821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty