Healthcare Provider Details

I. General information

NPI: 1285455956
Provider Name (Legal Business Name): JM DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 M 66
ATHENS MI
49011-9613
US

IV. Provider business mailing address

PO BOX 156
ATHENS MI
49011-0156
US

V. Phone/Fax

Practice location:
  • Phone: 269-729-9430
  • Fax: 269-659-8604
Mailing address:
  • Phone: 269-729-9430
  • Fax: 269-659-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAMIE BARTMAN
Title or Position: OWNER
Credential: DMD
Phone: 269-651-6700