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General NPI Number Information
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NPI Number | 1285060780
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Entity Type | Organization
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Legal Business Name | MARK W. TOURNELL, D.D.S., PLLC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 5010 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3725
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Country | US
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Telephone | 616-942-0840
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3725
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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
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Name | DR. MARK TOURNELL
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Credential | D.D.S.
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Telephone | 616-942-0840
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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 | J11639
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License Number State | MI
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