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General NPI Number Information
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NPI Number | 1841974847
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Entity Type | Organization
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Legal Business Name | NORTHPOINTE DENTAL AND IMPLANT CENTER OF WYOMING PLLC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 680 3 MILE RD NW STE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-8218
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Country | US
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Telephone | 616-288-6134
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Fax | 616-825-6338
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Provider Business Mailing Address
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Address Line | 5601 WILSON AVE SW
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City | WYOMING
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State | MI
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Zip | 49418-9353
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Country | US
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Telephone | 616-334-6500
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | SUK JUN YUN
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Credential | DDS
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Telephone | 616-334-6500
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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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