Provider Demographics
NPI:1457896953
Name:NATHANIEL P MUTCH DDS, PLLC
Entity Type:Organization
Organization Name:NATHANIEL P MUTCH DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-664-4542
Mailing Address - Street 1:381 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2662
Mailing Address - Country:US
Mailing Address - Phone:810-664-4542
Mailing Address - Fax:810-664-3580
Practice Address - Street 1:381 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2662
Practice Address - Country:US
Practice Address - Phone:810-664-4542
Practice Address - Fax:810-664-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty