Provider Demographics
NPI:1821482829
Name:DRJ OF EIGHT MILE PLLC
Entity Type:Organization
Organization Name:DRJ OF EIGHT MILE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:313-582-8150
Mailing Address - Street 1:5050 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3249
Mailing Address - Country:US
Mailing Address - Phone:313-582-8150
Mailing Address - Fax:313-582-0745
Practice Address - Street 1:511 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1004
Practice Address - Country:US
Practice Address - Phone:313-582-8150
Practice Address - Fax:313-582-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty