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General NPI Number Information
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NPI Number | 1245351592
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Entity Type | Organization
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Legal Business Name | PHARES FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 291 W LAKEWOOD BLVD
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City | HOLLAND
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State | MI
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Zip | 49424-1969
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Country | US
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Telephone | 616-396-7502
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Fax |
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Provider Business Mailing Address
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Address Line | 291 W LAKEWOOD BLVD
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City | HOLLAND
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State | MI
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Zip | 49424-1969
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER,PARTNER
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Name | THOMAS CHASE PHARES
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Credential | DDS
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Telephone | 616-396-7502
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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 | 2901017663
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License Number State | MI
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