Organization
JEWELL LAKE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN RODRIGUEZ DDS (OWNER)
(989) 736-7000
Entity
Organization
Contact information
Practice address
1889 W TRASK LAKE RD, BARTON CITY, MI 48705
(989) 736-7000
Mailing address
1889 W TRASK LAKE RD, PO BOX 193, BARTON CITY, MI 48705
(989) 736-7000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901015703
MI
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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