State Street Family Dental

NPI #1669604484 in Saint Johns, Michigan

Provider Information

NPI Number: 1669604484
Entity Type: Organization
Organization Name: State Street Family Dental
Primary Specialty: Dentist
Enumeration Date: Aug 12, 2009
Last Updated: Aug 12, 2009

Practice Location

Address: 100 S SCOTT RD
City: Saint Johns
State: Michigan
ZIP Code: 48879-9038
Phone: (989) 227-1858

Authorized Official

Name: JENNIFER NICOLE OSBORNE
Title: OFFICE MANAGER
Phone: (989) 227-1858

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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