Provider Demographics
NPI:1750168274
Name:VILLAGE FAMILY DENTAL
Entity type:Organization
Organization Name:VILLAGE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KAECHELE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-456-9972
Mailing Address - Street 1:VILLAGE FAMILY DENTAL
Mailing Address - Street 2:1671 WEST US HWY 12
Mailing Address - City:CLINTON, MI, USA
Mailing Address - State:MI
Mailing Address - Zip Code:49236
Mailing Address - Country:US
Mailing Address - Phone:517-456-9972
Mailing Address - Fax:517-456-9973
Practice Address - Street 1:VILLAGE FAMILY DENTAL
Practice Address - Street 2:1671 WEST US HWY 12
Practice Address - City:CLINTON, MI, USA
Practice Address - State:MI
Practice Address - Zip Code:49236
Practice Address - Country:US
Practice Address - Phone:517-456-9972
Practice Address - Fax:517-456-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental