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General NPI Number Information
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NPI Number | 1700171774
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Entity Type | Individual
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Provider Name | PATRICK JAMES CONDIT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 2541 INDIAN TRL SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3116
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Country | US
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Telephone | 616-560-7384
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Fax |
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Provider Business Mailing Address
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Address Line | 2541 INDIAN TRL SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3116
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.028956
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021476
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-02-3894
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License Number State | OH
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