Provider Demographics
NPI:1689444622
Name:VILLAGE FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:VILLAGE FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-489-3974
Mailing Address - Street 1:1671 WEST US HWY 12
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236
Mailing Address - Country:US
Mailing Address - Phone:517-456-9972
Mailing Address - Fax:517-456-9973
Practice Address - Street 1:1671 WEST US HWY 12
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236
Practice Address - Country:US
Practice Address - Phone:517-456-9972
Practice Address - Fax:517-456-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental