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General NPI Number Information
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NPI Number | 1396547451
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Entity Type | Organization
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Legal Business Name | COLOMA DENTAL PLLC
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 213 N PAW PAW ST
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City | COLOMA
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State | MI
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Zip | 49038-9589
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Country | US
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Telephone | 269-468-5741
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Fax |
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Provider Business Mailing Address
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Address Line | 1499 STARK AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49534-2270
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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. HANNAH NELSON
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Credential | DDS
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Telephone | 616-460-0159
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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 |
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License Number State |
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