Provider Demographics
NPI:1053536706
Name:JOSTOCK, MICHAEL ERICH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERICH
Last Name:JOSTOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:MICHAEL
Other - Last Name:JOSTOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:38951 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2990
Mailing Address - Country:US
Mailing Address - Phone:586-978-8233
Mailing Address - Fax:586-978-8516
Practice Address - Street 1:38951 RYAN RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2990
Practice Address - Country:US
Practice Address - Phone:586-978-8233
Practice Address - Fax:586-978-8516
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID110711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice