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General NPI Number Information
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NPI Number | 1194421909
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Entity Type | Organization
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Legal Business Name | AFFINITY DENTAL CARE PLC
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 2807 LAKE MICHIGAN DR NW STE 3
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-5831
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Country | US
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Telephone | 678-462-0499
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 141547
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City | GRAND RAPIDS
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State | MI
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Zip | 49514-1547
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Country | US
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Telephone | 404-207-2605
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MANUEL R ALE
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Credential | MBA
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Telephone | 404-207-2605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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