Provider Demographics
NPI:1578255428
Name:JACQUELYN CHU D.D.S.,P.C.
Entity Type:Organization
Organization Name:JACQUELYN CHU D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:KWONG
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-489-7008
Mailing Address - Street 1:32905 W 12 MILE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3374
Mailing Address - Country:US
Mailing Address - Phone:248-489-7008
Mailing Address - Fax:248-489-7038
Practice Address - Street 1:32905 W 12 MILE RD STE 350
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3374
Practice Address - Country:US
Practice Address - Phone:248-489-7008
Practice Address - Fax:248-489-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental