Healthcare Provider Details

I. General information

NPI: 1922532399
Provider Name (Legal Business Name): NYLAAN DENTAL PROPERTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1050
US

IV. Provider business mailing address

5011 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1050
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-7317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN NYLAAN
Title or Position: OWNER
Credential:
Phone: 616-361-7317