Healthcare Provider Details

I. General information

NPI: 1164068136
Provider Name (Legal Business Name): POSTHUMUS FAMILY DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 3 MILE RD NE
GRAND RAPIDS MI
49505-3956
US

IV. Provider business mailing address

2300 3 MILE RD NE
GRAND RAPIDS MI
49505-3956
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-3712
  • Fax: 616-363-4285
Mailing address:
  • Phone: 616-363-3712
  • Fax: 616-363-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID POSTHUMUS
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 616-363-3712