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General NPI Number Information
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NPI Number | 1033223250
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY ASSOCIATES, PC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 01/16/2018
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Provider Practice Location Address
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Address Line | 2144 E PARIS AVE SE STE 150
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6126
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Country | US
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Telephone | 616-942-2000
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Fax | 616-942-6805
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Provider Business Mailing Address
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Address Line | 2144 E PARIS AVE SE STE 150
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6126
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Country | US
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Telephone | 616-942-2000
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Fax | 616-942-6805
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH J MULDER
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Credential | DDS, MS
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Telephone | 616-942-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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