Provider Demographics
NPI:1831237171
Name:KACIR, DAVID C (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:KACIR
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23000 GREATER MACK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1977
Mailing Address - Country:US
Mailing Address - Phone:586-776-6400
Mailing Address - Fax:586-776-6410
Practice Address - Street 1:23000 GREATER MACK AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1977
Practice Address - Country:US
Practice Address - Phone:586-776-6400
Practice Address - Fax:586-776-6410
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010180691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice