Provider Demographics
NPI:1326164609
Name:MERTZ, JENNIFER KUESTER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KUESTER
Last Name:MERTZ
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32981 BROOKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1426
Mailing Address - Country:US
Mailing Address - Phone:734-786-0108
Mailing Address - Fax:
Practice Address - Street 1:18342 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3219
Practice Address - Country:US
Practice Address - Phone:313-881-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics