Healthcare Provider Details

I. General information

NPI: 1447322920
Provider Name (Legal Business Name): AMRU ALBEIRUTI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 CASCADE RD SE STE 204
GRAND RAPIDS MI
49546-8422
US

IV. Provider business mailing address

5070 CASCADE RD SE STE 204
GRAND RAPIDS MI
49546-8422
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-5920
  • Fax:
Mailing address:
  • Phone: 616-805-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901018631
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: