Healthcare Provider Details

I. General information

NPI: 1508752528
Provider Name (Legal Business Name): JOSHUA WANSTEN DDS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 WEALTHY ST SE STE 100
GRAND RAPIDS MI
49506-3055
US

IV. Provider business mailing address

2249 WEALTHY ST SE STE 100
GRAND RAPIDS MI
49506-3055
US

V. Phone/Fax

Practice location:
  • Phone: 616-454-8228
  • Fax:
Mailing address:
  • Phone:
  • 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. JOSHUA WANSTEN
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 616-460-5567