Healthcare Provider Details

I. General information

NPI: 1841974847
Provider Name (Legal Business Name): NORTHPOINTE DENTAL AND IMPLANT CENTER OF WYOMING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 3 MILE RD NW STE B
GRAND RAPIDS MI
49544-8218
US

IV. Provider business mailing address

5601 WILSON AVE SW
WYOMING MI
49418-9353
US

V. Phone/Fax

Practice location:
  • Phone: 616-288-6134
  • Fax: 616-825-6338
Mailing address:
  • Phone: 616-334-6500
  • 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: SUK JUN YUN
Title or Position: DDS
Credential: DDS
Phone: 616-334-6500