Jake Brejnak
Individual provider Active NPI Dentist · Davison, MI
NPI 1801467352 · NPPES record last updated Jul 6, 2021
Key facts
- NPI
- 1801467352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5307010959 (MI)
- Practice address
- 9096 Davison Rd
Davison, MI 48423-1037 - Phone
- (810) 653-2212
- NPI assigned
- Jul 6, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5307010959 | MI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5307010959 | MI | Yes |
Addresses
Primary practice location
9096 Davison Rd
Davison, MI 48423-1037
Mailing address
4735 Jasmond Rd
Goodrich, MI 48438-9676
Phone (810) 358-5212
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Davison |
Other providers in Davison, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.