MEDICARE: JOHN JAMNIK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	13582	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85771	OTHER	MI	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245248962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JAMNIK D.D.S.

Provider Business Mailing Address
First Line	:	5285 IROQUOIS CT
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-3013
Country	:	US
Telephone Number	:	248-394-1853
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 ORCHARD LAKE RD
Second Line	:
City	:	KEEGO HARBOR
State	:	MI
Zip	:	48320-1446
Country	:	US
Telephone Number	:	248-682-0922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	12/03/2015

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