MEDICARE: JEFFREY NORMAN DZINGLE DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	MI2901019121	MI
2	1223E0200X	Endodontics	2901019121	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MI2901019121	OTHER	MI	MI LICENSE

General Provider Information

NPI Number	:	1730213000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY NORMAN DZINGLE DDS, MS

Provider Business Mailing Address
First Line	:	3120 PRIMROSE LN
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-3214
Country	:	US
Telephone Number	:	734-717-2686
Fax Number	:	989-773-0904

Provider Business Practice Location Address
First Line	:	146 S INDUSTRIAL DR
Second Line	:
City	:	SALINE
State	:	MI
Zip	:	48176-9493
Country	:	US
Telephone Number	:	989-772-1334
Fax Number	:	989-773-0904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	12/01/2011

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