Healthcare Provider Details

I. General information

NPI: 1588326730
Provider Name (Legal Business Name): THORNAPPLE DENTAL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6886 CASCADE RD SE STE G
GRAND RAPIDS MI
49546-6879
US

IV. Provider business mailing address

3195 NATURE VIEW DR SE
KENTWOOD MI
49512-9348
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-4777
  • Fax:
Mailing address:
  • Phone: 989-309-0236
  • 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. LAURYNE VANDERHOOF
Title or Position: OWNER
Credential: DDS
Phone: 989-309-0236