Provider Demographics
NPI:1992912802
Name:GRAYLING FAMILY DENTISTRY
Entity type:Organization
Organization Name:GRAYLING FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RIEGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-348-4300
Mailing Address - Street 1:1664 HARTWICK PINES RD
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-9237
Mailing Address - Country:US
Mailing Address - Phone:989-348-4300
Mailing Address - Fax:989-344-8055
Practice Address - Street 1:1664 HARTWICK PINES RD
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-9237
Practice Address - Country:US
Practice Address - Phone:989-348-4300
Practice Address - Fax:989-344-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010125521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty