Provider Demographics
NPI:1639185085
Name:KORDICH, DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:KORDICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-796-4747
Mailing Address - Fax:231-796-5711
Practice Address - Street 1:201 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1809
Practice Address - Country:US
Practice Address - Phone:231-796-4747
Practice Address - Fax:231-796-5711
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901013080OtherSTATE LICENSE