Individual
JACKSON LOUIS NORTHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2024 HEALTH DR SW STE A, WYOMING, MI 49519-9501
(616) 455-7370
Mailing address
2024 HEALTH DR SW STE A, WYOMING, MI 49519-9501
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901603017
MI
Other
Enumeration date
05/21/2026
Last updated
05/21/2026
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