Provider Demographics
NPI:1508313230
Name:RODNEY GRAMBEAU FAMILY DENTISTRY
Entity Type:Organization
Organization Name:RODNEY GRAMBEAU FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-347-2188
Mailing Address - Street 1:2044 E MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9603
Mailing Address - Country:US
Mailing Address - Phone:231-347-2188
Mailing Address - Fax:
Practice Address - Street 1:2044 E MITCHELL RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9603
Practice Address - Country:US
Practice Address - Phone:231-347-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011049261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental