Organization
PEDIATRIC DENTISTRY AND ORTHODONTICS OF JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LY JULIE VAN DDS (PEDIATRIC DENTIST)
(586) 744-9869
Entity
Organization
Contact information
Practice address
900 E MICHIGAN AVE STE 100, JACKSON, MI 49201-2457
(517) 376-3142
Mailing address
900 E MICHIGAN AVE STE 100, JACKSON, MI 49201-2457
(517) 376-3142
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
03/07/2022
Last updated
03/07/2022
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