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Individual
DR. TIMOTHY M. JUNGBLUT
Active
Individual
DR. TIMOTHY M. JUNGBLUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901016115
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901016115
STATE LICENSE #
MI
01
—
796159
UNITED CONCORDIA PROVIDER
MI
Enumeration date
04/13/2007
Last updated
03/07/2023
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