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General NPI Number Information
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NPI Number | 1407390107
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Entity Type | Organization
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Legal Business Name | SPRING ARBOR DENTAL PLLC
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 2532 SPRING ARBOR RD UNIT 4
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City | JACKSON
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State | MI
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Zip | 49203-3663
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Country | US
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Telephone | 517-789-8622
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Fax | 517-789-8636
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Provider Business Mailing Address
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Address Line | 2532 SPRING ARBOR RD UNIT 4
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City | JACKSON
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State | MI
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Zip | 49203-3663
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Country | US
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Telephone | 517-789-8622
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Fax | 517-789-8636
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. SHERRI L JENNINGS
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Credential |
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Telephone | 517-789-8622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19622
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 21829
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License Number State | MI
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