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General NPI Number Information
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NPI Number | 1689106189
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Entity Type | Organization
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Legal Business Name | POINTE FISHER DENTAL
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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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 | 48230-1674
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Country | US
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Telephone | 313-882-1490
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Fax |
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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 | 48230-1674
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Country | US
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Telephone | 313-882-1490
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER HOLTZMAN
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901019538
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License Number State | MI
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