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General NPI Number Information
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NPI Number | 1164068136
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Entity Type | Organization
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Legal Business Name | POSTHUMUS FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 2300 3 MILE RD NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3956
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Country | US
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Telephone | 616-363-3712
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Fax | 616-363-4285
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Provider Business Mailing Address
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Address Line | 2300 3 MILE RD NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3956
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Country | US
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Telephone | 616-363-3712
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Fax | 616-363-4285
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. DAVID POSTHUMUS
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Credential | DDS
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Telephone | 616-363-3712
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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 |
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License Number State |
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