Provider Demographics
NPI:1740403187
Name:DEE, JOHN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:DEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E GENESEE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1242
Mailing Address - Country:US
Mailing Address - Phone:989-754-2171
Mailing Address - Fax:989-752-3678
Practice Address - Street 1:301 E GENESEE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1242
Practice Address - Country:US
Practice Address - Phone:989-754-2171
Practice Address - Fax:989-752-3678
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009533122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4053067Medicaid
MI971414OtherUNITED CONCORDIA
MIMI9533OtherBLUE CROSSBLUE SHIELD