Healthcare Provider Details

I. General information

NPI: 1730213000
Provider Name (Legal Business Name): JEFFREY NORMAN DZINGLE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 S INDUSTRIAL DR
SALINE MI
48176-9493
US

IV. Provider business mailing address

3120 PRIMROSE LN
YPSILANTI MI
48197-3214
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-1334
  • Fax: 989-773-0904
Mailing address:
  • Phone: 734-717-2686
  • Fax: 989-773-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberMI2901019121
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901019121
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: