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:
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Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720039878 NPPES
Michigan MEDICAID 4066190

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