Provider Demographics
NPI:1639814684
Name:S. RANGRASS DDS PC
Entity Type:Organization
Organization Name:S. RANGRASS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SECORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-929-1555
Mailing Address - Street 1:1719 E G AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1703
Mailing Address - Country:US
Mailing Address - Phone:269-382-5327
Mailing Address - Fax:269-382-2129
Practice Address - Street 1:1719 E G AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49004-1703
Practice Address - Country:US
Practice Address - Phone:269-382-5327
Practice Address - Fax:269-382-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center