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Organization

MICHIGAN DENTISTS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHERYL NOTTEN (OFFICE MANAGER)
(517) 787-5367
Entity
Organization

Contact information

Practice address
2641 SHIRLEY DR, JACKSON, MI 49201-8633
(517) 787-5367
Mailing address
2641 SHIRLEY DR, JACKSON, MI 49201-8633
(517) 787-5367

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
305S00000X
Point of Service

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1295090611
EDWIN KWON
MI
01
1518251230
ANISH GUPTA
MI
01
1952617284
FIRAS BELBEISI
MI
Enumeration date
07/23/2020
Last updated
01/25/2021
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