Healthcare Provider Details

I. General information

NPI: 1609920040
Provider Name (Legal Business Name): NATASA URUKALO-HARSHMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 3 MILE RD NW STE A
GRAND RAPIDS MI
49544-8203
US

IV. Provider business mailing address

976 3 MILE RD NW STE A
GRAND RAPIDS MI
49544-8203
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-4038
  • Fax: 616-785-9501
Mailing address:
  • Phone: 616-784-4038
  • Fax: 616-785-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901017692
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: