Bruce A. Jackson II, DDS, Plc
Clinic/Center, Dental in Grand Rapids, MI. Organization (NPI-2).
NPI number1639783137
StatusActive
Last updated in NPPESSep 2, 2020
Details
- NPI
- 1639783137
- Entity type
- Organization (NPI-2)
- Legal business name
- Bruce A. Jackson II, DDS, Plc
- Organization subpart
- No
- Enumeration date
- Sep 2, 2020
- Certification date
- Sep 2, 2020
- Last updated
- Sep 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
4829 E Beltline Ave NeGrand Rapids, MI 49525-9747
Phone 616-363-8707
Mailing address
4829 E Beltline Ave NeGrand Rapids, MI 49525-9747
Phone 616-363-8707
Authorized official
Bruce Jackson
Owner
6163638707
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