Healthcare Provider Details

I. General information

NPI: 1942335583
Provider Name (Legal Business Name): JANA TUMPKIN MCQUEEN D.D.S. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S LIVERNOIS RD
ROCHESTER HILLS MI
48307-1837
US

IV. Provider business mailing address

29702 SOUTHFIELD RD STE H
SOUTHFIELD MI
48076-2096
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-3100
  • Fax:
Mailing address:
  • Phone: 248-559-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901015114
License Number StateMI

VIII. Authorized Official

Name: JANA TUMPKIN MCQUEEN
Title or Position: OWNER
Credential: DDS
Phone: 248-559-4800