Healthcare Provider Details

I. General information

NPI: 1487262820
Provider Name (Legal Business Name): CAREPOINT DENTAL ANESTHESIA GROUP OF MICHIGAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 E PARIS AVE SE STE 130
GRAND RAPIDS MI
49546-3682
US

IV. Provider business mailing address

8301 E PRENTICE AVE STE 215
GREENWOOD VILLAGE CO
80111-2990
US

V. Phone/Fax

Practice location:
  • Phone: 616-226-1370
  • Fax: 616-327-6370
Mailing address:
  • Phone: 720-606-4220
  • Fax: 720-606-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA JACKSTIEN
Title or Position: OWNER/MANAGING PARTNER
Credential: DMD
Phone: 720-414-3611