Provider Demographics
NPI:1730213000
Name:DZINGLE, JEFFREY NORMAN (DDS, MS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:NORMAN
Last Name:DZINGLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3214
Mailing Address - Country:US
Mailing Address - Phone:734-717-2686
Mailing Address - Fax:989-773-0904
Practice Address - Street 1:146 S INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9493
Practice Address - Country:US
Practice Address - Phone:989-772-1334
Practice Address - Fax:989-773-0904
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI29010191211223G0001X
MI29010191211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2901019121OtherMI LICENSE