Healthcare Provider Details

I. General information

NPI: 1972896207
Provider Name (Legal Business Name): JONATHAN HEKMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE ROOM 2008, SPC 1078
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

9353 ENCHANTMENT DR SE
ALTO MI
49302-9500
US

V. Phone/Fax

Practice location:
  • Phone: 734-615-8606
  • Fax:
Mailing address:
  • Phone: 616-366-2091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901020383
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: