Healthcare Provider Details

I. General information

NPI: 1235847773
Provider Name (Legal Business Name): THREE RIVERS JM DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N HOOKER AVE
THREE RIVERS MI
49093-2231
US

IV. Provider business mailing address

17 VINEWOOD AVE
STURGIS MI
49091-2375
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-3065
  • Fax:
Mailing address:
  • Phone: 269-651-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE BARTMAN
Title or Position: OWNER
Credential: DDS
Phone: 269-651-6700