Provider Demographics
NPI:1922339662
Name:GENERATIONS DENTAL
Entity Type:Organization
Organization Name:GENERATIONS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-852-6430
Mailing Address - Street 1:245 BARCLAY CIR
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5815
Mailing Address - Country:US
Mailing Address - Phone:248-852-6430
Mailing Address - Fax:248-852-7703
Practice Address - Street 1:245 BARCLAY CIR
Practice Address - Street 2:SUITE 900
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5815
Practice Address - Country:US
Practice Address - Phone:248-852-6430
Practice Address - Fax:248-852-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty