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General NPI Number Information
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NPI Number | 1437111218
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Entity Type | Organization
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Legal Business Name | JENNINGS DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 383 FISHER RD
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City | GROSSE POINTE
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State | MI
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Zip | 48230
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Country | US
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Telephone | 313-882-1490
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Fax | 313-882-3140
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Provider Business Mailing Address
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Address Line | 383 FISHER RD
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City | GROSSE POINTE
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State | MI
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Zip | 48230
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Country | US
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Telephone | 313-882-1490
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Fax | 313-882-3140
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. WILLIAM GEORGE JENNINGS
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Credential | DDS
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Telephone | 313-882-1490
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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 | 00994
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License Number State | MI
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