Healthcare Provider Details

I. General information

NPI: 1942384292
Provider Name (Legal Business Name): WIILLIAM A. PATCHAK D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W WASHINGTON AVE SUITE 105
JACKSON MI
49201-2169
US

IV. Provider business mailing address

306 W WASHINGTON AVE SUITE 105
JACKSON MI
49201-2169
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-8340
  • Fax: 517-788-8343
Mailing address:
  • Phone: 517-788-8340
  • Fax: 517-788-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901011397
License Number StateMI

VIII. Authorized Official

Name: DR. WILLIAM ALLAN PATCHAK
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 517-788-8340