| Fourth Street Dental, Pllc | |
|
2027 4th St Jackson MI 49203-4572 | |
| (517) 787-9630 | |
| Not Available |
| Full Name | Fourth Street Dental, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2027 4th St, Jackson, Michigan |
| Authorized Official Name and Position | Nathan Shane Pound (MEMBER) |
| Authorized Official Contact | 5177879630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fourth Street Dental, Pllc 2027 4th St Jackson MI 49203-4572 Ph: (517) 787-9630 | Fourth Street Dental, Pllc 2027 4th St Jackson MI 49203-4572 Ph: (517) 787-9630 |
| NPI Number | 1710303599 |
|---|---|
| Provider Enumeration Date | 03/17/2014 |
| Last Update Date | 03/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710303599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19773 (Michigan) | Primary |
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