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General NPI Number Information
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NPI Number | 1548027063
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Entity Type | Organization
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Legal Business Name | JACKSON DENTAL INNOVATIONS PLLC
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 1931 HORTON RD STE 14
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City | JACKSON
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State | MI
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Zip | 49203-5599
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Country | US
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Telephone | 517-787-7520
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Fax | 517-787-2575
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Provider Business Mailing Address
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Address Line | 190 PLYMOUTH RD
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City | PLYMOUTH
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State | MI
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Zip | 48170-1447
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Country | US
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Telephone | 734-979-0979
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Fax | 734-927-1169
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | SHADI KRECHT
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Credential | DMD
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Telephone | 734-979-0979
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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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