Provider Demographics
NPI:1194819995
Name:LINK, JEFFREY OSCAR (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:OSCAR
Last Name:LINK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5090 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7637
Mailing Address - Country:US
Mailing Address - Phone:810-445-9970
Mailing Address - Fax:810-445-9971
Practice Address - Street 1:5090 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7637
Practice Address - Country:US
Practice Address - Phone:104-459-9708
Practice Address - Fax:810-445-9971
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010137741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3209898Medicaid
MID137740OtherBCBS DENTAL
MI3209870Medicaid
MIJL013774OtherBCBS
MI842026OtherUNITED CONCORDIA
MIU50171Medicare UPIN