=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609992296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARMBRECHT ORTHODONTICS PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 43RD ST SE STE A
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49508-8700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-455-4800
-----------------------------------------------------
Fax | 616-455-0930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 43RD ST SE STE A
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49508-8700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-455-4800
-----------------------------------------------------
Fax | 616-455-0930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. GARY DICKSON ARMBRECHT
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 616-455-4800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 10386
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------