Provider Demographics
NPI:1942616958
Name:ELDERLY ORAL HEALTH CARE CONSULTING
Entity Type:Organization
Organization Name:ELDERLY ORAL HEALTH CARE CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:313-220-9660
Mailing Address - Street 1:25572 W 12 MILE RD
Mailing Address - Street 2:204
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8047
Mailing Address - Country:US
Mailing Address - Phone:313-220-9660
Mailing Address - Fax:
Practice Address - Street 1:25572 W 12 MILE RD
Practice Address - Street 2:204
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8047
Practice Address - Country:US
Practice Address - Phone:313-220-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty