Healthcare Provider Details

I. General information

NPI: 1649229493
Provider Name (Legal Business Name): WESTSHORE ENDODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S WASHINGTON AVE SUITE 110
HOLLAND MI
49423-7724
US

IV. Provider business mailing address

904 S WASHINGTON AVE SUITE 110
HOLLAND MI
49423-7724
US

V. Phone/Fax

Practice location:
  • Phone: 616-392-6385
  • Fax: 616-392-9779
Mailing address:
  • Phone: 616-392-6385
  • Fax: 616-392-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901010230
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES RAY HOWARD
Title or Position: ENDODONTIST
Credential: D.D.S., M.S.
Phone: 616-392-6385