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General NPI Number Information
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NPI Number | 1891921854
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Entity Type | Individual
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Provider Name | KALISHA LEONE MORIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 545 MICHIGAN AVE
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City | HOLLAND
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State | MI
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Zip | 49423-4749
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Country | US
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Telephone | 616-396-1058
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Fax |
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Provider Business Mailing Address
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Address Line | 6305 NORFOLK DR
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City | NORTON SHORES
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State | MI
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Zip | 49444-7895
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Country | US
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Telephone | 231-360-4522
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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 | 2901020007
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License Number State | MI
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