Provider Demographics
NPI:1174808463
Name:MIKE PIERCE DDS P.C.
Entity type:Organization
Organization Name:MIKE PIERCE DDS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-526-9611
Mailing Address - Street 1:289 E MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-1511
Mailing Address - Country:US
Mailing Address - Phone:231-526-9611
Mailing Address - Fax:231-526-2051
Practice Address - Street 1:289 E MAIN ST.
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-1511
Practice Address - Country:US
Practice Address - Phone:231-526-9611
Practice Address - Fax:231-526-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901008277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty