Provider Demographics
NPI:1700962420
Name:TU, BACHTRAC (DDS)
Entity Type:Individual
Prefix:DR
First Name:BACHTRAC
Middle Name:
Last Name:TU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3557
Mailing Address - Country:US
Mailing Address - Phone:517-349-3266
Mailing Address - Fax:517-347-1750
Practice Address - Street 1:2476 JOLLY ROAD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4886
Practice Address - Country:US
Practice Address - Phone:517-349-3266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700962420OtherDENTAL NPI