| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 254 West Rd, Trenton, Michigan |
| Authorized Official Name and Position | Noel William Jackson (PRESIDENT) |
| Authorized Official Contact | 7346712273 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
24 West Rd. Trenton MI 48183-2916 Ph: (734) 671-2273 | 254 West Rd Trenton MI 48183-2916 Ph: (734) 671-2273 |
| NPI Number | 1720147820 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720147820 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901012191 (Michigan) | Primary |
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