Healthcare Provider Details

I. General information

NPI: 1841801941
Provider Name (Legal Business Name): GRAND RAPIDS FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1644
US

IV. Provider business mailing address

212 PECAN DR
SUMMERVILLE SC
29483-4918
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-8716
  • 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: KATELYN PALMATEER
Title or Position: OWNER
Credential: DMD
Phone: 810-650-3511