Provider Demographics
NPI:1245363837
Name:MESICK DENTAL CENTER, PC
Entity type:Organization
Organization Name:MESICK DENTAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-885-1711
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:5055 N M-37
Mailing Address - City:MESICK
Mailing Address - State:MI
Mailing Address - Zip Code:49668-0489
Mailing Address - Country:US
Mailing Address - Phone:231-885-1711
Mailing Address - Fax:
Practice Address - Street 1:5055 N M 37
Practice Address - Street 2:
Practice Address - City:MESICK
Practice Address - State:MI
Practice Address - Zip Code:49668-9705
Practice Address - Country:US
Practice Address - Phone:231-885-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty