Fourth Street Dental, Pllc

NPI 1710303599 - Dentist - 1223G0001X

NPI Details
NPI 1710303599
Enumeration Date 03/17/2014
Last Updated 03/17/2014
Entity Type Healthcare Provider
Active Over 2 years ago
Authorized Information
Name NATHAN SHANE NATHAN
Position MEMBER
Phone (517) 787-9630
Fax
Practice Location
2027 4TH ST
JACKSON MI, 49203-4572, US
Phone (517) 787-9630
Fax
Business Location
2027 4TH ST
JACKSON MI, 49203-4572, US
Phone (517) 787-9630
Fax
Toxanomy
Taxonomy Code 1223G0001X
License State Michigan
License Number 19773
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According to our database, Fourth Street Dental, Pllc NPI is 1710303599, taxonomy code is 1223G0001X and license number is 19773, license state is located at Michigan. Fourth Street Dental, Pllc physically located at 2027 4th St, Jackson MI, 49203-4572. NPI Number 1033115704 has the healthcare provider type.

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1710303599 NPI number is provided on an as is basis without warranty of any kind. 1710303599 is maintained by the National Plan & Provider Enumeration System. The contents of Fourth Street Dental, Pllc are for informational purposes only.