Provider Demographics
NPI:1700072543
Name:MY COMMUNITY DENTAL CENTERS INC
Entity type:Organization
Organization Name:MY COMMUNITY DENTAL CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ACCOUNTS RECEIVABLE SPECIALI
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LECLERC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-437-4737
Mailing Address - Street 1:3890 CHARLEVOIX RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8423
Mailing Address - Country:US
Mailing Address - Phone:231-437-4741
Mailing Address - Fax:231-582-2967
Practice Address - Street 1:3890 CHARLEVOIX RD STE 300
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8423
Practice Address - Country:US
Practice Address - Phone:231-547-7638
Practice Address - Fax:231-582-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty