Provider Demographics
NPI:1700191418
Name:WILLIAM R. DESJARDINS, DDS, PLLC
Entity Type:Organization
Organization Name:WILLIAM R. DESJARDINS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-536-2601
Mailing Address - Street 1:101 MAPLE RIDGE DR
Mailing Address - Street 2:PO BOX 571
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-8926
Mailing Address - Country:US
Mailing Address - Phone:231-536-2601
Mailing Address - Fax:231-536-2909
Practice Address - Street 1:101 MAPLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:EAST JORDAN
Practice Address - State:MI
Practice Address - Zip Code:49727-8926
Practice Address - Country:US
Practice Address - Phone:231-536-2601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty