NPI: 1285813949 · BIG RAPIDS, MI 49307 · Dentist · NPI assigned 10/30/2007
| Authorized Official | JACKSON, ANNETTE (DH CLINIC OPERATIONS SUPERVISOR) |
| NPI Enumeration Date | 10/30/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2019 | 21 | $452.50 |
| 2022 | 12 | $270.90 |
| 2023 | 12 | $285.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 45 | 45 | $1K |