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General NPI Number Information
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NPI Number | 1194888214
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Entity Type | Organization
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Legal Business Name | KEVIN P FLOOD D D S-P C
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 4990 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8416
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Country | US
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Telephone | 616-974-4990
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Fax | 616-974-4999
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Provider Business Mailing Address
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Address Line | 4990 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8416
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Country | US
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Telephone | 616-974-4990
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Fax | 616-974-4999
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KEVIN P FLOOD
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Credential | D D S-P C
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Telephone | 616-974-4990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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