Jackson, Bruce Arden
Jackson, Bruce Arden is an individual health care provider with primary practice located at 4829 E Beltline Ave Ne , Grand Rapids MI 49525-9747. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Jackson, Bruce Arden can be contacted via phone (616) 363-8707.Contact Information
Primary practice address
4829 E Beltline Ave Ne
Grand Rapids MI 49525-9747
Phone: (616) 363-8707
Fax: (616) 363-0390
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 13162 | Michigan |
Profile Details
| NPI number | 1720039878 |
|---|---|
| LBN Legal business name | Jackson, Bruce Arden |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 13th, 2006 |
| Last updated | Sep 2nd, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720039878 | NPPES |
| Michigan | MEDICAID | 4066190 |
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