Healthcare Provider Details

I. General information

NPI: 1487055760
Provider Name (Legal Business Name): BRIAN JAMES ZIRKLE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 11/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 W GRAND RIVER AVE
OKEMOS MI
48864-1604
US

IV. Provider business mailing address

6922 CORRIGAN DR
BRIGHTON MI
48116-8852
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-0034
  • Fax: 517-347-9708
Mailing address:
  • Phone: 517-375-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021248
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: