Martin George Raebel II, DDS
Individual provider Active NPI General Practice Dentistry · Douglas, MI
NPI 1679657407 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679657407
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 11620 (MI)
- Practice address
- 430 Wiley Road
Douglas, MI 49406 - Phone
- (269) 857-1431
- Fax
- (269) 857-4089
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11620 | MI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11620 | MI | Yes |
Addresses
Primary practice location
430 Wiley Road
Douglas, MI 49406
Mailing address
PO Box 109
430 Wiley Road
Douglas, MI 49406
Phone (269) 857-1431
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4274157 | Medicaid | MI |
Other providers in Douglas, MI
- Erica J Monroe
- Nanmax Health Management Inc
- Nicole Boxer, MD, PC
- Carrie Jean Ouvry
- Kailey Jean Price VII
- Richard C Annis OD PC
- Sara Ruiter
- Nathan Scripps I
- John Richard Shack
- Katherine R Smaller
All providers in Douglas, 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 Jul 8, 2007. 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.