Provider Demographics
NPI:1518116235
Name:MARINE CITY DENTAL, P.C.
Entity Type:Organization
Organization Name:MARINE CITY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:T
Authorized Official - Last Name:PERAINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-765-4055
Mailing Address - Street 1:162 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-1687
Mailing Address - Country:US
Mailing Address - Phone:810-765-4055
Mailing Address - Fax:810-765-4111
Practice Address - Street 1:162 S WATER ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-1687
Practice Address - Country:US
Practice Address - Phone:810-765-4055
Practice Address - Fax:810-765-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty