Provider Demographics
NPI:1528024320
Name:JANKOWSKI, RICHARD L (DSS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S PENNSYLVANIA AVE
Mailing Address - Street 2:#200
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-4795
Mailing Address - Country:US
Mailing Address - Phone:517-393-4900
Mailing Address - Fax:517-349-7019
Practice Address - Street 1:3333 S PENNSYLVANIA AVE
Practice Address - Street 2:#200
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4795
Practice Address - Country:US
Practice Address - Phone:517-393-4900
Practice Address - Fax:517-349-7019
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist