Provider Demographics
NPI:1104403401
Name:MOUNTFORD AND RUSZKOWSKI FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:MOUNTFORD AND RUSZKOWSKI FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MOUNTFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-575-1876
Mailing Address - Street 1:333 JACKSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1067
Mailing Address - Country:US
Mailing Address - Phone:616-842-0822
Mailing Address - Fax:
Practice Address - Street 1:333 JACKSON AVE STE A
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1067
Practice Address - Country:US
Practice Address - Phone:616-842-0822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty