Individual
JONATHON HENNING ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
555 S OLD WOODWARD AVE STE 777, BIRMINGHAM, MI 48009-6618
(248) 647-4700
(248) 647-4730
Mailing address
555 S OLD WOODWARD AVE STE 777, BIRMINGHAM, MI 48009-6618
(248) 647-4700
(248) 647-4730
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901012981
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2990516
—
MI
05
—
4067429
—
MI
01
—
970F31085
BCBSM
MI
01
—
JA012981
LICENSE NUMBER
MI
Enumeration date
11/16/2005
Last updated
10/15/2018
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