Provider Demographics
NPI:1295146413
Name:KALAMAZOO PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:KALAMAZOO PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BASLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-343-5386
Mailing Address - Street 1:1900 WHITES RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2872
Mailing Address - Country:US
Mailing Address - Phone:269-343-5386
Mailing Address - Fax:269-343-0913
Practice Address - Street 1:1900 WHITES RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2872
Practice Address - Country:US
Practice Address - Phone:269-343-5386
Practice Address - Fax:269-343-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty