Healthcare Provider Details

I. General information

NPI: 1073240891
Provider Name (Legal Business Name): PATRICK J. CONDIT DDS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4270 PLAINFIELD AVE NE STE D
GRAND RAPIDS MI
49525-1603
US

IV. Provider business mailing address

2641 BOSTON ST SE
GRAND RAPIDS MI
49506-4766
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-9497
  • Fax: 616-724-6434
Mailing address:
  • Phone: 616-560-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK JAMES CONDIT
Title or Position: MEMBER
Credential: DDS
Phone: 616-361-9497