Provider Demographics
NPI:1487262820
Name:CAREPOINT DENTAL ANESTHESIA GROUP OF MICHIGAN, PLLC
Entity type:Organization
Organization Name:CAREPOINT DENTAL ANESTHESIA GROUP OF MICHIGAN, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:720-414-3611
Mailing Address - Street 1:8301 E PRENTICE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2990
Mailing Address - Country:US
Mailing Address - Phone:720-606-4220
Mailing Address - Fax:720-606-2594
Practice Address - Street 1:1179 E PARIS AVE SE STE 130
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3682
Practice Address - Country:US
Practice Address - Phone:616-226-1370
Practice Address - Fax:616-327-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13430734Medicaid
1750728119OtherHEALTHY KIDS
CO9000193309Medicaid
CO41489268Medicaid