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General NPI Number Information
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NPI Number | 1316667462
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Entity Type | Organization
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Legal Business Name | ROOT CANAL SPECIALISTS NORTH, PLLC
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 4355 SAWKAW DR. NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1768
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Country | US
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Telephone | 616-361-6609
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Fax | 616-361-6248
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Provider Business Mailing Address
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Address Line | 4355 SAWKAW DR. NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1768
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Country | US
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Telephone | 616-361-6609
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Fax | 616-361-6248
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Authorized Official
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Title or Position | ENDODONTICS/C.F.O.
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Name | DR. JACK KEMPER
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Credential | D.M.D
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Telephone | 616-361-6609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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