Provider Demographics
NPI:1720148018
Name:KAMINSKI, JANE ALEXIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ALEXIS
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13204 E OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-4209
Mailing Address - Country:US
Mailing Address - Phone:313-885-2697
Mailing Address - Fax:313-882-6081
Practice Address - Street 1:5024 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2649
Practice Address - Country:US
Practice Address - Phone:313-882-8010
Practice Address - Fax:313-882-6081
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291014632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1790987Medicaid
MI382363069OtherPRACTICE TIN