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Organization
STATE STREET FAMILY DENTAL
Active
Organization
STATE STREET FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER NICOLE OSBORNE (OFFICE MANAGER)
(989) 227-1858
Entity
Organization
Contact information
Practice address
100 S SCOTT RD, SAINT JOHNS, MI 48879-9038
(989) 227-1858
(989) 227-2268
Mailing address
100 S SCOTT RD, SAINT JOHNS, MI 48879-9038
(989) 227-1858
(989) 227-2268
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
012271
MI
122300000X
Dentist
Primary
13188
MI
122300000X
Dentist
2901018410
MI
122300000X
Dentist
2901019279
MI
122300000X
Dentist
901013605
MI
Other
Enumeration date
08/12/2009
Last updated
08/12/2009
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