Provider Demographics
NPI:1285813949
Name:FERRIS STATE UNIVERSITY DENTAL HYGIENE CLINIC
Entity Type:Organization
Organization Name:FERRIS STATE UNIVERSITY DENTAL HYGIENE CLINIC
Other - Org Name:DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DH CLINIC OPERATIONS SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:URSULA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS
Authorized Official - Phone:231-591-2284
Mailing Address - Street 1:200 FERRIS DR
Mailing Address - Street 2:VFS 202
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2740
Mailing Address - Country:US
Mailing Address - Phone:231-591-2260
Mailing Address - Fax:231-591-3791
Practice Address - Street 1:200 FERRIS DR
Practice Address - Street 2:VFS 202
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2740
Practice Address - Country:US
Practice Address - Phone:231-591-2260
Practice Address - Fax:231-591-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty