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General NPI Number Information
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NPI Number | 1902668932
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Entity Type | Organization
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Legal Business Name | THIRD COAST DENTISTRY
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 330 LOVELL ST
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City | IONIA
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State | MI
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Zip | 48846-9706
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Country | US
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Telephone | 616-634-3068
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Fax |
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Provider Business Mailing Address
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Address Line | 201 FULTON ST W APT 1409
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2678
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Country | US
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Telephone | 269-303-2166
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIEF OPERATIONS OFFICER
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Name | NICK STEBBINS
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Credential | DMD
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Telephone | 269-303-2166
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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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