Provider Demographics
NPI:1538530209
Name:ATZMON, JODY (DDS)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:ATZMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N EVANS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1166
Mailing Address - Country:US
Mailing Address - Phone:734-425-0600
Mailing Address - Fax:
Practice Address - Street 1:603 N EVANS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1166
Practice Address - Country:US
Practice Address - Phone:517-317-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1005381223P0221X
NY0578781223P0221X
MI29010217121223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry