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General NPI Number Information
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NPI Number | 1265271720
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Entity Type | Organization
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Legal Business Name | HARBOR LIGHTS DENTAL CARE PLLC
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 575 ROBBINS RD SUITE B
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City | GRAND HAVEN
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State | MI
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Zip | 49417
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Country | US
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Telephone | 616-842-2850
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Fax | 616-842-7205
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Provider Business Mailing Address
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Address Line | 575 ROBBINS RD SUITE B
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City | GRAND HAVEN
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State | MI
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Zip | 49417
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Country | US
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Telephone | 616-842-2850
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Fax | 616-842-7205
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. COLIN WILLIAM PELLEGROM
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Credential | DDS
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Telephone | 616-842-2850
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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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