Provider Demographics
NPI:1992718167
Name:HELMUS, JEFFREY MARK (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:HELMUS
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 1:2663 44TH ST SW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4189
Mailing Address - Country:US
Mailing Address - Phone:616-538-7320
Mailing Address - Fax:616-538-7666
Practice Address - Street 1:2663 44TH ST SW
Practice Address - Street 2:SUITE 204
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4189
Practice Address - Country:US
Practice Address - Phone:616-538-7320
Practice Address - Fax:616-538-7666
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4633989Medicaid
MID188380OtherBCBS