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General NPI Number Information
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NPI Number | 1154065977
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Entity Type | Organization
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Legal Business Name | OKEMOS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 3985 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864-3692
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Country | US
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Telephone | 517-381-5244
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Fax | 517-381-5247
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Provider Business Mailing Address
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Address Line | 3985 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864-3692
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Country | US
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Telephone | 517-381-5244
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Fax | 517-381-5247
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELVIN S JUNG
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Credential | DMD
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Telephone | 517-381-5244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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