Provider Demographics
NPI:1235275843
Name:MACAJOUX, JEAN RICHARD
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:RICHARD
Last Name:MACAJOUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29401 PINE ROW TRL
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-7705
Mailing Address - Country:US
Mailing Address - Phone:786-942-4397
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 180
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-0180
Practice Address - Country:US
Practice Address - Phone:269-783-2495
Practice Address - Fax:269-782-4925
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN000141991223G0001X
MI2901602438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice