Professional Dental Associates PC
Organization Active NPI General Practice Dentistry · Baldwin, MI
NPI 1154592285 · NPPES record last updated Mar 17, 2008
Key facts
- NPI
- 1154592285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 10102 (MI)
- Legal business name
- PROFESSIONAL DENTAL ASSOCIATES PC
- Practice address
- 888 Michigan Ave
Baldwin, MI 49304 - Phone
- (231) 745-7231
- Fax
- (231) 745-7246
- NPI assigned
- Mar 17, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- PROFESSIONAL DENTAL ASSOCIATES PC
Authorized official
- Name
- Dr. Kevin T Mathewson, DDS
- Title
- Dentist Owner
- Phone
- (231) 796-3571
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Professional Denatl Asso PC
- Part of
- Professional Denatl Asso PC
Locations
888 Michigan Ave
Baldwin, MI 49304
Phone (231) 745-7231
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 10102 | MI | Yes |
| General Practice Dentistry |
1223G0001X | 16945 | MI | |
| General Practice Dentistry |
1223G0001X | 19296 | MA |
Addresses
Primary practice location
888 Michigan Ave
Baldwin, MI 49304
Mailing address
PO Box 152
888 Michigan Ave
Baldwin, MI 49304
Phone (231) 745-7231
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2007556 | Other | MI | UCCI |
| 8012380 | Other | MI | BCBS |
Other names
- Jensen Shroger Anderson PC
Other providers in Baldwin, MI
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- Wanda Jean Ottinger
- Pattie Drug of Baldwin Inc
- Jodie Marie Phillips
- Vernon Eugene Proctor
- Quest Diagnostics Clinical Laboratories Inc
- Quest Diagnostics Incorporated Mi
- Mark J Rajewski
- Virginia Maria Ramos
- Amanda Reed
All providers in Baldwin, MI · General Practice Dentistry in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.