Healthcare Provider Details

I. General information

NPI: 1003908575
Provider Name (Legal Business Name): ROBERT L KINTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E PARIS AVE SE SUITE 150
GRAND RAPIDS MI
49546-6111
US

IV. Provider business mailing address

6025 3 MILE RD NE
ADA MI
49301-9591
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2000
  • Fax: 616-942-6805
Mailing address:
  • Phone: 616-682-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberRK015332
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: