Healthcare Provider Details

I. General information

NPI: 1346307428
Provider Name (Legal Business Name): SCOTT ANTHONY PIROCHTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 EASTCASTLE DR SE SUITE B
GRAND RAPIDS MI
49508-8872
US

IV. Provider business mailing address

2017 EASTCASTLE DR SE SUITE B
GRAND RAPIDS MI
49508-8872
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-0220
  • Fax: 616-281-8333
Mailing address:
  • Phone: 616-281-0220
  • Fax: 616-281-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901015448
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: