Healthcare Provider Details

I. General information

NPI: 1336231497
Provider Name (Legal Business Name): DOWNRIVER DENTAL ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 FORT STREET
LINCOLN PARK MI
48146
US

IV. Provider business mailing address

3830 FORT ST.
LINCOLN PARK MI
48146
US

V. Phone/Fax

Practice location:
  • Phone: 313-383-6800
  • Fax: 313-383-1026
Mailing address:
  • Phone: 313-383-6800
  • Fax: 313-383-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD MARK GRUMET
Title or Position: VICE-PRESIDENT
Credential: D.D.S.
Phone: 313-383-6800