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General NPI Number Information
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NPI Number | 1376124552
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Entity Type | Organization
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Legal Business Name | JATIVA FAMILY DENTAL
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 147 W MICHIGAN AVE
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City | CLINTON
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State | MI
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Zip | 49236-9577
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Country | US
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Telephone | 517-456-7471
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | CLINTON
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State | MI
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Zip | 49236-0549
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Country | US
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Telephone | 517-456-7471
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Fax |
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Authorized Official
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Title or Position | FRONT OFFICE
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Name | MRS. MARCY SOSKO
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Credential |
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Telephone | 517-456-7471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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