Provider Demographics
NPI:1831286400
Name:FENTON FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:FENTON FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BUFORD
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:SHUMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-629-2361
Mailing Address - Street 1:118 W SHIAWASSEE AVE
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2006
Mailing Address - Country:US
Mailing Address - Phone:810-629-2361
Mailing Address - Fax:810-629-7925
Practice Address - Street 1:118 W SHIAWASSEE AVE
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2006
Practice Address - Country:US
Practice Address - Phone:810-629-2361
Practice Address - Fax:810-629-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty