Provider Demographics
NPI:1659980308
Name:DEHNE DENTAL PLLC
Entity Type:Organization
Organization Name:DEHNE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:NASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-895-7400
Mailing Address - Street 1:5916 LAKE MICHIGAN DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8111
Mailing Address - Country:US
Mailing Address - Phone:616-895-7400
Mailing Address - Fax:616-895-4375
Practice Address - Street 1:5916 LAKE MICHIGAN DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8111
Practice Address - Country:US
Practice Address - Phone:616-895-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty