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General NPI Number Information
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NPI Number | 1588326730
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Entity Type | Organization
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Legal Business Name | THORNAPPLE DENTAL PLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 6886 CASCADE RD SE STE G
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6879
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Country | US
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Telephone | 616-940-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 3195 NATURE VIEW DR SE
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City | KENTWOOD
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State | MI
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Zip | 49512-9348
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Country | US
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Telephone | 989-309-0236
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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. LAURYNE VANDERHOOF
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Credential | DDS
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Telephone | 989-309-0236
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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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