Provider Demographics
NPI:1306373824
Name:MARLETTE FAM DENTISTRY PLLC
Entity type:Organization
Organization Name:MARLETTE FAM DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PANKRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:989-269-8401
Mailing Address - Street 1:3149 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1255
Mailing Address - Country:US
Mailing Address - Phone:989-635-7541
Mailing Address - Fax:989-635-2414
Practice Address - Street 1:3149 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1255
Practice Address - Country:US
Practice Address - Phone:989-635-7541
Practice Address - Fax:989-635-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty