Organization
JACKSON IMPLANTS & PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MISCH DDS, MS (OWNER/PERIODONTIST)
(734) 975-1743
Entity
Organization
Contact information
Practice address
721 17TH STREET, JACKSON, MI 49203
(517) 782-3607
(517) 782-3658
Mailing address
721 17TH STREET, JACKSON, MI 49203
(517) 782-3607
(517) 782-3658
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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