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General NPI Number Information
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NPI Number | 1841801941
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Entity Type | Organization
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Legal Business Name | GRAND RAPIDS FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 4701 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1644
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Country | US
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Telephone | 616-364-8716
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Fax |
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Provider Business Mailing Address
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Address Line | 212 PECAN DR
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City | SUMMERVILLE
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State | SC
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Zip | 29483-4918
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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 | KATELYN PALMATEER
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Credential | DMD
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Telephone | 810-650-3511
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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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