Healthcare Provider Details

I. General information

NPI: 1902827157
Provider Name (Legal Business Name): HERNLY FAMILY AND COSMETIC DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 PARCHMENT DR SE SUITE 115
GRAND RAPIDS MI
49546-2303
US

IV. Provider business mailing address

847 PARCHMENT DR SE SUITE 115
GRAND RAPIDS MI
49546-2303
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-1731
  • Fax: 616-957-4420
Mailing address:
  • Phone: 616-957-1731
  • Fax: 616-957-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18009
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID J HERNLY
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 616-957-1731