Healthcare Provider Details

I. General information

NPI: 1437227758
Provider Name (Legal Business Name): SANFORD JAY NITZKIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33428 FIVE MILE RD
LIVONIA MI
48154
US

IV. Provider business mailing address

33428 FIVE MILE RD
LIVONIA MI
48154
US

V. Phone/Fax

Practice location:
  • Phone: 734-427-7555
  • Fax: 734-427-1233
Mailing address:
  • Phone: 734-427-7555
  • Fax: 734-427-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14658
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: