Jennifer Lynn Deblouw, DDS
Individual provider Active NPI Dentist · Saint Clair, MI
NPI 1902397862 · NPPES record last updated Jun 26, 2020
Key facts
- NPI
- 1902397862
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901022632 (MI)
- Practice address
- 1980 Fred W Moore Hwy
Saint Clair, MI 48079-4701 - Phone
- (810) 329-7440
- NPI assigned
- May 25, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180703001910 | MI | Order and Referring Only - Dentist |
7517213630 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901022632 | MI | MD | Dentist |
| 22632 | MI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deblouw Family Dentistry | Current |
Accepting new patients | |
| Lisa Zemens DDS PC | General Practice | Past |
Accepting new patients |
Locations
1980 Fred W Moore Hwy
Saint Clair, MI 48079
Phone (810) 329-7440
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22632 | MI | |
| Dentist | 122300000X | 2901022632 | MI | Yes |
Addresses
Primary practice location
1980 Fred W Moore Hwy
Saint Clair, MI 48079-4701
Mailing address
26551 24 Mile Rd
Chesterfield, MI 48051-1515
Phone (810) 531-0142
Other providers in Saint Clair, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.