Provider Demographics
NPI:1992764443
Name:WASSENAAR FRUTIGER WASSENAAR DDS PC
Entity type:Organization
Organization Name:WASSENAAR FRUTIGER WASSENAAR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRUTIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-463-5392
Mailing Address - Street 1:226 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801
Mailing Address - Country:US
Mailing Address - Phone:989-463-5392
Mailing Address - Fax:989-463-3973
Practice Address - Street 1:226 N STATE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801
Practice Address - Country:US
Practice Address - Phone:989-463-5392
Practice Address - Fax:989-463-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID13742122300000X
MID14164122300000X
MI1559191122300000X
MID18900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty