Provider Demographics
NPI:1154558898
Name:KITRIDGE ANDERSON, DDS PC
Entity type:Organization
Organization Name:KITRIDGE ANDERSON, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KITRIDGE
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-733-8533
Mailing Address - Street 1:4080 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ONAWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49765-8852
Mailing Address - Country:US
Mailing Address - Phone:989-733-8533
Mailing Address - Fax:989-733-8533
Practice Address - Street 1:4080 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765-8852
Practice Address - Country:US
Practice Address - Phone:989-733-8533
Practice Address - Fax:989-733-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-21
Last Update Date:2009-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI173751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty