Healthcare Provider Details

I. General information

NPI: 1932365020
Provider Name (Legal Business Name): GERARD PAUL BOSSCHER JR. DDS, MS.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 SAWKAW, N.E.
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

4353 SAWKAW, N.E.
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-9821
  • Fax: 616-365-9206
Mailing address:
  • Phone: 616-363-9821
  • Fax: 616-365-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901011010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: