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General NPI Number Information
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NPI Number | 1598160483
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Entity Type | Organization
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Legal Business Name | FERRIS STATE UNIVERSITY
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 200 FERRIS DR
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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 | 231-591-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 200 FERRIS DR
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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 | 231-591-3130
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Fax |
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Authorized Official
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Title or Position | SEALANT COORDINATOR
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Name | MS. JAMIE FREITAG
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Credential | RDH
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Telephone | 231-591-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902011248
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902002544
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902004089
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901018836
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License Number State | MI
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