Provider Demographics
NPI:1790881902
Name:DWAN, JEFFREY JOHN (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOHN
Last Name:DWAN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 N CENTER RD
Mailing Address - Street 2:STE 5
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638
Mailing Address - Country:US
Mailing Address - Phone:989-790-3636
Mailing Address - Fax:989-790-3635
Practice Address - Street 1:595 N CENTER RD
Practice Address - Street 2:STE 5
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638
Practice Address - Country:US
Practice Address - Phone:989-790-3636
Practice Address - Fax:989-790-3635
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010145011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics