Provider Demographics
NPI:1962658054
Name:ACHEY, ELIAS JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:JOHN
Last Name:ACHEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1083
Mailing Address - Country:US
Mailing Address - Phone:231-893-2915
Mailing Address - Fax:231-893-4917
Practice Address - Street 1:116 W COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1083
Practice Address - Country:US
Practice Address - Phone:231-893-2915
Practice Address - Fax:231-893-4917
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0194591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice