Provider Demographics
NPI:1104523588
Name:STANDISH DENTAL
Entity type:Organization
Organization Name:STANDISH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-846-9545
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658
Mailing Address - Country:US
Mailing Address - Phone:989-846-9545
Mailing Address - Fax:989-846-2010
Practice Address - Street 1:117 N FOREST ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-2506
Practice Address - Country:US
Practice Address - Phone:989-846-9545
Practice Address - Fax:989-846-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental