Provider Demographics
NPI:1376262501
Name:DR. RICHARD C. PFOTENHAUER FAMILY DENTISTRY
Entity type:Organization
Organization Name:DR. RICHARD C. PFOTENHAUER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PFOTENHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-428-1325
Mailing Address - Street 1:116 N 9TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-1660
Mailing Address - Country:US
Mailing Address - Phone:906-428-1325
Mailing Address - Fax:906-428-2659
Practice Address - Street 1:116 N 9TH ST STE B
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837-1660
Practice Address - Country:US
Practice Address - Phone:906-428-1325
Practice Address - Fax:906-428-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty