Healthcare Provider Details

I. General information

NPI: 1407773872
Provider Name (Legal Business Name): NORTH PARK FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N PARK ST NE
GRAND RAPIDS MI
49525-2580
US

IV. Provider business mailing address

422 N PARK ST NE
GRAND RAPIDS MI
49525-2580
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-7265
  • Fax:
Mailing address:
  • Phone: 616-361-7265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA ROBERT DAME
Title or Position: ASSOCIATE DENTIST
Credential: DDS
Phone: 616-361-7265