Provider Demographics
NPI:1376793307
Name:DZINGLE, JEREMY NORMAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:NORMAN
Last Name:DZINGLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 14 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7308
Mailing Address - Country:US
Mailing Address - Phone:616-263-9207
Mailing Address - Fax:
Practice Address - Street 1:4655 14 MILE RD NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7308
Practice Address - Country:US
Practice Address - Phone:616-263-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010199001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice