Basic Information
| Provider Information | |||||||||
| NPI: | 1942724612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMTHUN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | DAVID | ||||||||
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| NameSuffix: | |||||||||
| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1131 S OCEANA DR | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494559634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2312863134 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 119 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494551243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318612130 | ||||||||
| FaxNumber: | 2318610019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2017 | ||||||||
| LastUpdateDate: | 08/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2902018266 | MI | Y | Dental Providers | Dental Hygienist |
No ID Information.