Provider Demographics
NPI:1689645053
Name:DENTAL HEALTH PROFESSIONALS
Entity Type:Organization
Organization Name:DENTAL HEALTH PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-775-9797
Mailing Address - Street 1:7800 US 131 S
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8437
Mailing Address - Country:US
Mailing Address - Phone:231-775-9797
Mailing Address - Fax:231-775-9793
Practice Address - Street 1:7800 US 131 S
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8437
Practice Address - Country:US
Practice Address - Phone:231-775-9797
Practice Address - Fax:231-775-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110881223G0001X
MI110251223G0001X
MI118421223G0001X
MI153511223G0001X
MI192251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI121637750Medicaid
MI121637732Medicaid
MI124038196Medicaid
MI124993571Medicaid
MI122633451Medicaid