Healthcare Provider Details

I. General information

NPI: 1457033367
Provider Name (Legal Business Name): ANDREW SCHWEITZER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 ROWE AVE
PORTLAND MI
48875-1645
US

IV. Provider business mailing address

5021 VERDURE PKWY APT 36
GRAND RAPIDS MI
49512-5531
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-6205
  • Fax:
Mailing address:
  • Phone: 808-233-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901601898
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: