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General NPI Number Information
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NPI Number | 1689444622
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Entity Type | Organization
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Legal Business Name | VILLAGE FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 1671 WEST US HWY 12 SUITE B
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City | CLINTON
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State | MI
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Zip | 49236
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Country | US
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Telephone | 517-456-9972
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Fax | 517-456-9973
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Provider Business Mailing Address
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Address Line | 1671 WEST US HWY 12 SUITE B
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City | CLINTON
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State | MI
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Zip | 49236
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Country | US
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Telephone | 517-456-9972
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Fax | 517-456-9973
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Authorized Official
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Title or Position | OWNER
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Name | HELIN JACKSI
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Credential | DDS
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Telephone | 734-489-3974
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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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