Healthcare Provider Details

I. General information

NPI: 1194344580
Provider Name (Legal Business Name): ROBERT JAY AULT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 W ST JOE HWY STE 203
LANSING MI
48917-4850
US

IV. Provider business mailing address

6105 W ST JOE HWY STE 203
LANSING MI
48917-4850
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-0800
  • Fax: 517-220-2172
Mailing address:
  • Phone: 517-351-0800
  • Fax: 517-220-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901600453
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901600453
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901600453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: