Provider Demographics
NPI:1679200190
Name:BANDY DENTAL, PLLC
Entity Type:Organization
Organization Name:BANDY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-444-4169
Mailing Address - Street 1:411 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1627
Mailing Address - Country:US
Mailing Address - Phone:248-444-4169
Mailing Address - Fax:
Practice Address - Street 1:411 S BROAD ST
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-1627
Practice Address - Country:US
Practice Address - Phone:248-444-4169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental