Healthcare Provider Details

I. General information

NPI: 1114687720
Provider Name (Legal Business Name): ZANG-BODIS ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 HASLETT RD STE 1
EAST LANSING MI
48823-6927
US

IV. Provider business mailing address

4274 SUGAR MAPLE LN
OKEMOS MI
48864-3225
US

V. Phone/Fax

Practice location:
  • Phone: 734-395-7375
  • Fax:
Mailing address:
  • Phone: 734-395-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ZANG-BODIS
Title or Position: DOCTOR/OWNER
Credential:
Phone: 734-395-7375