# DENTISTRY BY DESIGN OF JACKSON, PLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DENTISTRY BY DESIGN OF JACKSON, PLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396276333
- **Legal business name:** DENTISTRY BY DESIGN OF JACKSON, PLC
- **Authorized official:** DR. ANDREW JAMES BALAZE D.M.D. (DENTIST/OWNER)
- **Authorized official phone:** (517) 787-5055

## Contact information

- **Practice address:** 306 W WASHINGTON AVE STE 205, JACKSON, MI 49201-2141
- **Practice address phone:** (517) 787-5055
- **Practice address fax:** (517) 787-9346
- **Mailing address:** 306 W WASHINGTON AVE STE 205, JACKSON, MI 49201-2141
- **Mailing address phone:** (517) 787-5055
- **Mailing address fax:** (517) 787-9346

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901020967 | MI | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 03/22/2017
- **Last updated:** 08/07/2019