Provider Demographics
NPI:1922625821
Name:DEBLOUW FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DEBLOUW FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEBLOUW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-329-7440
Mailing Address - Street 1:1980 FRED W MOORE HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-4701
Mailing Address - Country:US
Mailing Address - Phone:810-329-7440
Mailing Address - Fax:
Practice Address - Street 1:1980 FRED W MOORE HWY
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-4701
Practice Address - Country:US
Practice Address - Phone:810-329-7440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental