Provider Demographics
NPI:1659596195
Name:JOSTOCK DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:JOSTOCK DENTAL ASSOCIATES, P.C.
Other - Org Name:MICHAEL E.JOSTOCK D.D.S. P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERICH
Authorized Official - Last Name:JOSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-978-8233
Mailing Address - Street 1:38951 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2990
Mailing Address - Country:US
Mailing Address - Phone:586-978-8233
Mailing Address - Fax:586-978-8516
Practice Address - Street 1:38951 RYAN RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2990
Practice Address - Country:US
Practice Address - Phone:586-978-8233
Practice Address - Fax:586-978-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID11071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty