Provider Demographics
NPI:1316126022
Name:JENNINGS, WILLIAM GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1674
Mailing Address - Country:US
Mailing Address - Phone:313-882-1490
Mailing Address - Fax:313-882-3140
Practice Address - Street 1:383 FISHER RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1674
Practice Address - Country:US
Practice Address - Phone:313-882-1490
Practice Address - Fax:313-882-3140
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI99941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice