Healthcare Provider Details

I. General information

NPI: 1447995261
Provider Name (Legal Business Name): 3 MILE FAMILY DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
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:
Mailing address:
  • Phone: 616-784-4038
  • 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: DR. NATASA URUKALO-HARSHMAN
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 616-784-4038