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Organization
MICHIGAN DENTISTS PLLC
Active
Organization
MICHIGAN DENTISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL NOTTEN (OFFICE MANAGER)
(517) 787-5367
Entity
Organization
Contact information
Practice address
2641 SHIRLEY DR, JACKSON, MI 49201-8633
(517) 787-5367
Mailing address
2641 SHIRLEY DR, JACKSON, MI 49201-8633
(517) 787-5367
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295090611
EDWIN KWON
MI
01
—
1518251230
ANISH GUPTA
MI
01
—
1952617284
FIRAS BELBEISI
MI
Enumeration date
07/23/2020
Last updated
01/25/2021
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