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General NPI Number Information
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NPI Number | 1295164556
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Entity Type | Organization
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Legal Business Name | HOLLAND FREE HEALTH CLINIC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 99 W 26TH ST
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City | HOLLAND
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State | MI
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Zip | 49423-4970
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Country | US
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Telephone | 616-392-3610
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Fax | 616-392-3632
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Provider Business Mailing Address
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Address Line | 99 W 26TH ST
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City | HOLLAND
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State | MI
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Zip | 49423-4970
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Country | US
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Telephone | 616-392-3610
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Fax | 616-392-3632
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Authorized Official
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Title or Position | DENTAL PROGRAM MANAGER
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Name | MS. TARA L KIMBALL
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Credential | RDH
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Telephone | 616-392-3610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902010638
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License Number State | MI
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