Individual
JENNA PUTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
610 N PINE RIVER ST, ITHACA, MI 48847
(989) 875-2888
Mailing address
610 N PINE RIVER ST, ITHACA, MI 48847
(989) 875-2888
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901021389
MI
1223G0001X
General Practice Dentistry
30.023844
OH
Other
Enumeration date
10/01/2012
Last updated
12/10/2015
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