Provider Demographics
NPI:1982396958
Name:JAISLE, MICHAEL RYAN (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:JAISLE
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 1:1060 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8101
Mailing Address - Country:US
Mailing Address - Phone:248-417-1411
Mailing Address - Fax:
Practice Address - Street 1:1060 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8101
Practice Address - Country:US
Practice Address - Phone:989-217-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601836122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist