Healthcare Provider Details

I. General information

NPI: 1831570555
Provider Name (Legal Business Name): RICHARD S NEUMAN DDS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 BURTON ST SE
GRAND RAPIDS MI
49546-5819
US

IV. Provider business mailing address

3930 BURTON ST SE
GRAND RAPIDS MI
49546-5819
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-9183
  • Fax: 616-956-1527
Mailing address:
  • Phone: 616-956-9183
  • Fax: 616-956-1527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901014274
License Number StateMI

VIII. Authorized Official

Name: LISA KLEIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-956-9183