Provider Demographics
NPI:1518534668
Name:SIGNATURE DENTAL
Entity Type:Organization
Organization Name:SIGNATURE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-686-1700
Mailing Address - Street 1:800 S EUCLID AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3355
Mailing Address - Country:US
Mailing Address - Phone:989-686-1700
Mailing Address - Fax:989-631-2865
Practice Address - Street 1:800 S EUCLID AVE STE 4
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3355
Practice Address - Country:US
Practice Address - Phone:989-686-1700
Practice Address - Fax:989-631-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty