Provider Demographics
NPI:1245949221
Name:ROBERT W. JANSEN DDS & ASSOCIATES PC
Entity type:Organization
Organization Name:ROBERT W. JANSEN DDS & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-292-0771
Mailing Address - Street 1:923 N. OAKLAND STREET
Mailing Address - Street 2:
Mailing Address - City:ST. JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879
Mailing Address - Country:US
Mailing Address - Phone:989-224-2968
Mailing Address - Fax:989-224-2474
Practice Address - Street 1:923 N. OAKLAND STREET
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879
Practice Address - Country:US
Practice Address - Phone:989-224-2968
Practice Address - Fax:989-224-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty