Healthcare Provider Details

I. General information

NPI: 1194855155
Provider Name (Legal Business Name): COUNTY OF KENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

IV. Provider business mailing address

700 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

V. Phone/Fax

Practice location:
  • Phone: 616-632-7120
  • Fax: 616-632-7083
Mailing address:
  • Phone: 616-632-7120
  • Fax: 616-632-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2901020199
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BAKOS
Title or Position: FINANCE SUPERVISOR
Credential:
Phone: 616-632-7244