Organization
FOURTH STREET DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN SHANE POUND D.D.S. (MEMBER)
(517) 787-9630
Entity
Organization
Contact information
Practice address
2027 4TH ST, JACKSON, MI 49203-4572
(517) 787-9630
Mailing address
2027 4TH ST, JACKSON, MI 49203-4572
(517) 787-9630
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19773
MI
Other
Enumeration date
03/17/2014
Last updated
03/17/2014
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