Healthcare Provider Details

I. General information

NPI: 1992612428
Provider Name (Legal Business Name): BLUE STAR FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

05055 BLUE STAR M HWY
SOUTH HAVEN MI
49090-7135
US

IV. Provider business mailing address

4737 MACATAWA LEGENDS BLVD
HOLLAND MI
49424-7453
US

V. Phone/Fax

Practice location:
  • Phone: 248-917-8048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS SCHULTZ
Title or Position: PRACTICE OWNER
Credential: DMD
Phone: 248-917-8048