MEDICARE: WESTSIDE DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1669840559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE DENTAL PC

Provider Business Mailing Address
First Line	:	2005 LEONARD ST NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3827
Country	:	US
Telephone Number	:	616-453-5331
Fax Number	:	616-453-9235

Provider Business Practice Location Address
First Line	:	2005 LEONARD ST NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3827
Country	:	US
Telephone Number	:	616-453-5331
Fax Number	:	616-453-9235

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ALLYSON B MULDER
Credential	:	D.M.D.
Telephone Number	:	616-453-5331

Provider Enumeration Date	:	09/09/2015
Last Update Date	:	06/07/2016

Similar Medicare Providers

1881958411 — DR. ALLYSON BURGESS MULDER D.M.D
Practice Location Address:

2005 LEONARD ST NW
GRAND RAPIDS, MI
49504-3827

Practice Phone: 616-453-5331
Practice Fax: 616-453-9235

1619469046 — ERIN NARTKER DDS
Practice Location Address:

2005 LEONARD ST NW
GRAND RAPIDS, MI
49504-3827

Practice Phone: 616-453-5331
Practice Fax:

1356542286 — MS. KATHERINE SUE FISHER PT
Practice Location Address:

921 ALGER ST SE
GRAND RAPIDS, MI
49507-3827

Practice Phone: 616-819-7050
Practice Fax:

1457367757 — THRIFTY PAYLESS INC
Practice Location Address:

220 EAST GRAND AVENUE
EL SEGUNDO, CA
90245-3827

Practice Phone: 310-640-2715
Practice Fax:

1861618902 — MRS. LAURA BAUTISTA ABERNATHY
Practice Location Address:

220 E GRAND AVE
EL SEGUNDO, CA
90245-3827

Practice Phone: 310-640-2715
Practice Fax: 310-640-0804

1245474451 — FADI ADEL GOBRAN PHARMD
Practice Location Address:

220 E GRAND AVE
EL SEGUNDO, CA
90245-3827

Practice Phone: 310-640-2715
Practice Fax: 310-640-0804

Directions to “WESTSIDE DENTAL PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.