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General NPI Number Information
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NPI Number | 1932224920
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Entity Type | Organization
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Legal Business Name | GENTLE DENTAL GRAND RIVER PLLC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 02/21/2011
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Provider Practice Location Address
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Address Line | 13874 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48227-3123
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Country | US
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Telephone | 313-834-4900
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Fax | 313-835-1334
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Provider Business Mailing Address
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Address Line | 13874 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48227-3123
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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 | INSURANCE DIRECTOR
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Name | MIKE COLE
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Credential |
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Telephone | 727-726-1611
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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 |
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License Number State |
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