NPI: 1356951156 · SAINT CLAIR SHORES, MI 48080 · General Practice Dentistry · NPI assigned 08/06/2020
| Authorized Official | JACOBS, JONATHAN (OWNER) |
| NPI Enumeration Date | 08/06/2020 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 13 | $257.80 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 13 | 13 | $257.80 |