Provider Demographics
NPI:1467845362
Name:WOODLAND FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:WOODLAND FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL-MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-821-4746
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:HIGGINS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48627-0356
Mailing Address - Country:US
Mailing Address - Phone:989-821-4746
Mailing Address - Fax:989-821-5566
Practice Address - Street 1:315 W HIGGINS LAKE DR
Practice Address - Street 2:
Practice Address - City:HIGGINS LAKE
Practice Address - State:MI
Practice Address - Zip Code:48627
Practice Address - Country:US
Practice Address - Phone:989-821-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017455261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental