Mark Christopher Wolanin, D.D.S.
Individual provider Active NPI General Practice Dentistry · Riley, MI
NPI 1699875476 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1699875476
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 13676 (MI)
- Practice address
- 33065 Bordman Rd
Riley, MI 48041-4309 - Phone
- (810) 392-3186
- Fax
- (810) 392-3186
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160324002245 | MI | Order and Referring Only - Dentist |
5597722066 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13676 | MI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13676 | MI | Yes |
Addresses
Primary practice location
33065 Bordman Rd
Riley, MI 48041-4309
Mailing address
33065 Bordman Rd
Riley, MI 48041-4309
Phone (810) 392-3186
Other providers in Riley, MI
All providers in Riley, 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.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.