Healthcare Provider Details

I. General information

NPI: 1235341827
Provider Name (Legal Business Name): PAUL J KARL DDS MCLD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3989 CASCADE ROAD
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

3989 CASCADE ROAD
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7171
  • Fax: 616-459-7181
Mailing address:
  • Phone: 616-459-7171
  • Fax: 616-459-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: