Provider Demographics
NPI:1609934041
Name:JEAN E DRISCOLL DDS MS PC
Entity Type:Organization
Organization Name:JEAN E DRISCOLL DDS MS PC
Other - Org Name:JEAN DRISCOLL GILLILAND DDS MS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:810-667-7581
Mailing Address - Street 1:793 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3094
Mailing Address - Country:US
Mailing Address - Phone:810-667-7591
Mailing Address - Fax:810-667-7594
Practice Address - Street 1:793 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3094
Practice Address - Country:US
Practice Address - Phone:810-667-7591
Practice Address - Fax:810-667-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty