Provider Demographics
NPI:1407390107
Name:SPRING ARBOR DENTAL PLLC
Entity Type:Organization
Organization Name:SPRING ARBOR DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-789-8622
Mailing Address - Street 1:2532 SPRING ARBOR RD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3663
Mailing Address - Country:US
Mailing Address - Phone:517-789-8622
Mailing Address - Fax:517-789-8636
Practice Address - Street 1:2532 SPRING ARBOR RD
Practice Address - Street 2:UNIT 4
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3663
Practice Address - Country:US
Practice Address - Phone:517-789-8622
Practice Address - Fax:517-789-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI196221223G0001X
MI218291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty