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General NPI Number Information
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NPI Number | 1609019439
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Entity Type | Organization
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Legal Business Name | IONIA FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 430 SWARTZ CT
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City | IONIA
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State | MI
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Zip | 48846-2139
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Country | US
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Telephone | 616-527-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 430 SWARTZ CT
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City | IONIA
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State | MI
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Zip | 48846-2139
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Country | US
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Telephone | 616-527-4930
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. TAMI JEAN FENEIS
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Credential |
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Telephone | 616-527-4930
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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 | 15925
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License Number State | MI
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