Provider Demographics
NPI:1508400771
Name:DANDRON, MARGARET M
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:DANDRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:M
Other - Last Name:DANDRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5740 TWIN LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48632
Mailing Address - Country:US
Mailing Address - Phone:989-544-3550
Mailing Address - Fax:
Practice Address - Street 1:5740 TWIN LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAKE
Practice Address - State:MI
Practice Address - Zip Code:48632
Practice Address - Country:US
Practice Address - Phone:989-544-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF180076531311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility