Search › Michigan › 1223G0001X
Justin Distelrath
NPI 1881255966 · on the registry since 2019
Practice
- Address
- 1795 W Stadium Blvd
Ann Arbor, MI 48103 - Phone
- (734) 677-8700
- Fax
- (734) 839-4137
- Organisation at this address
- Ann Arbor Smiles Haddock Pllc
Kristin F. Nickodemus, Dds, PlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 5
Additional practice sites
- 2365 S Huron Pkwy, Ann Arbor, MI
Registry record
- Primary taxonomy
- 1223G0001X
1223G0001X
- Licence states on file
- MI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2022-09-12
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan