Healthcare Provider Details

I. General information

NPI: 1538530209
Provider Name (Legal Business Name): JODY ATZMON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N EVANS ST
TECUMSEH MI
49286-1166
US

IV. Provider business mailing address

603 N EVANS ST
TECUMSEH MI
49286-1166
US

V. Phone/Fax

Practice location:
  • Phone: 517-317-8700
  • Fax:
Mailing address:
  • Phone: 734-425-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number100538
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number057878
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901021712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: