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General NPI Number Information
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NPI Number | 1285813949
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Entity Type | Organization
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Legal Business Name | FERRIS STATE UNIVERSITY DENTAL HYGIENE CLINIC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 FERRIS DR VFS 202
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City | BIG RAPIDS
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State | MI
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Zip | 49307-2740
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Country | US
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Telephone | 231-591-2260
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Fax | 231-591-3791
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Provider Business Mailing Address
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Address Line | 200 FERRIS DR VFS 202
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City | BIG RAPIDS
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State | MI
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Zip | 49307-2740
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Country | US
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Telephone | 231-591-2260
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Fax | 231-591-3791
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Authorized Official
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Title or Position | DH CLINIC OPERATIONS SUPERVISOR
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Name | MRS. ANNETTE URSULA JACKSON
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Credential | RDH, BS
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Telephone | 231-591-2284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | MI
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