Healthcare Provider Details

I. General information

NPI: 1063347870
Provider Name (Legal Business Name): JOSHUA ROBERT DAME DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603182
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: