Provider Demographics
NPI:1023681772
Name:DR. TEDDERS OFFICE PLLC
Entity type:Organization
Organization Name:DR. TEDDERS OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-748-9440
Mailing Address - Street 1:3595 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2703
Mailing Address - Country:US
Mailing Address - Phone:517-748-9440
Mailing Address - Fax:517-748-9442
Practice Address - Street 1:3595 ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2703
Practice Address - Country:US
Practice Address - Phone:517-748-9440
Practice Address - Fax:517-748-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental