Provider Demographics
NPI:1881328763
Name:BACHELDER, MARY MARGARET (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BACHELDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:BACHELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-7697
Mailing Address - Country:US
Mailing Address - Phone:989-275-0725
Mailing Address - Fax:
Practice Address - Street 1:135 LAKE ST
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-7697
Practice Address - Country:US
Practice Address - Phone:989-275-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016014881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice