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General NPI Number Information
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NPI Number | 1134360019
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Entity Type | Organization
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Legal Business Name | STONECASTLE DENTISTRY PLLC
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 455 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4658
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Country | US
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Telephone | 616-458-8593
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Fax | 616-458-0738
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Provider Business Mailing Address
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Address Line | 455 CHERRY ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4658
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Country | US
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Telephone | 616-458-8593
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Fax | 616-458-0738
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Authorized Official
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Title or Position | OWNER
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Name | JON C FEINAUER
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Credential | DDS
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Telephone | 616-458-8593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901011979
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License Number State | MI
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