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DR. RICHARD CHARLES PFOTENHAUER D.D.S., P.C.
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1972530178
Individual Registrant:DR. RICHARD CHARLES PFOTENHAUER D.D.S., P.C.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
823 DELTA AVE GLADSTONE, MI 49837-1646 US
Tel: 906-428-1325 Fax: --
Tel: 906-428-1325 Fax: --
Contact information for business:
116 N 9TH ST STE B GLADSTONE, MI 49837-1660 US
Tel: 906-428-1325 Fax: --
Tel: 906-428-1325 Fax: --
Registration Information:
NPI: 1972530178
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | MI | 2901013893 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| EMPLOYER IDENTIFICATION N | 383575211 | MI | 01 |
