Healthcare Provider Details

I. General information

NPI: 1912441353
Provider Name (Legal Business Name): AMI WARD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMI CHRISTNER

II. Dates (important events)

Enumeration Date: 12/04/2016
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

2543 S SANDSTONE RD
JACKSON MI
49201-9374
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-5500
  • Fax:
Mailing address:
  • Phone: 517-769-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902011055
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: