MEDICARE: FOURTH STREET DENTAL, PLLC

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	1223G0001X	General Practice Dentistry	19773	MI

General Provider Information

NPI Number	:	1710303599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOURTH STREET DENTAL, PLLC

Provider Business Mailing Address
First Line	:	2027 4TH ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4572
Country	:	US
Telephone Number	:	517-787-9630
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 4TH ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4572
Country	:	US
Telephone Number	:	517-787-9630
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	NATHAN SHANE POUND
Credential	:	D.D.S.
Telephone Number	:	517-787-9630

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	03/17/2014

Similar Medicare Providers

1578421160 — OUT OF THE WOODS MENTAL HEALTH LLC
Practice Location Address:

2017 4TH ST
JACKSON, MI
49203-4572

Practice Phone: 517-745-5969
Practice Fax:

1154604064 — DR. KELLI LYNN BOGUE AU.D.
Practice Location Address:

2027 4TH ST
JACKSON, MI
49203-4572

Practice Phone: 517-888-5055
Practice Fax: 517-888-5052

1073956710 — MRS. AMBER JOY NORWOOD LMSW
Practice Location Address:

2017 4TH ST
JACKSON, MI
49203-4572

Practice Phone: 517-581-4886
Practice Fax: 517-905-6046

1417335076 — JENNIFER J FITCH LMSW
Practice Location Address:

2017 4TH ST
JACKSON, MI
49203-4572

Practice Phone: 517-798-2098
Practice Fax:

1194177675 — WAVES OF CHANGE, LLC
Practice Location Address:

2017 4TH ST
JACKSON, MI
49203-4572

Practice Phone: 517-581-4886
Practice Fax: 517-905-6046

1568903185 — COMMUNITY HEARING CENTER LLC
Practice Location Address:

2027 4TH ST
JACKSON, MI
49203-4572

Practice Phone: 740-804-1131
Practice Fax:

Directions to “FOURTH STREET DENTAL, PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.