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General NPI Number Information
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NPI Number | 1386320257
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Entity Type | Organization
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Legal Business Name | THE DENTAL HOUSE PLLC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 660 CROSWELL AVE. SE
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City | EAST GRAND RAPIDS
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State | MI
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Zip | 49506
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Country | US
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Telephone | 616-266-2611
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Fax | 616-282-1709
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Provider Business Mailing Address
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Address Line | 660 CROSWELL AVE. SE
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City | EAST GRAND RAPIDS
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State | MI
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Zip | 49506
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Country | US
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Telephone | 616-266-2611
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Fax | 616-282-1709
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Authorized Official
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Title or Position | OWNER
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Name | BROCKTON RICHARD WILLEY
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Credential | DDS
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Telephone | 616-266-2611
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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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