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General NPI Number Information
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NPI Number | 1891142931
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES & IMPLANTS - GRANDVILLE, P.C.
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 4485 CANAL AVE SW STE C600
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City | GRANDVILLE
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State | MI
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Zip | 49418-2691
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Country | US
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Telephone | 616-249-2603
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Fax |
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Provider Business Mailing Address
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Address Line | 4485 CANAL AVE SW STE C600
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City | GRANDVILLE
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State | MI
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Zip | 49418-2691
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Country | US
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Telephone | 616-249-2603
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Fax |
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Authorized Official
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Title or Position | DDS/PRACTICE OWNER
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Name | WALLACE WALKER
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Credential |
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Telephone | 616-249-2603
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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 | 2901012881
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License Number State | MI
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