=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952456832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD MICHAEL KONEN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2015 BRIDGE ST NW
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49504-4783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-453-5448
-----------------------------------------------------
Fax | 616-453-5895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2015 BRIDGE ST NW
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49504-4783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-453-5448
-----------------------------------------------------
Fax | 616-453-5895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D142110
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------