MEDICARE: PARCHMENT FAMILY DENTISTRY, LLC

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	:	1720537764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARCHMENT FAMILY DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	847 PARCHMENT DR SE
Second Line	:	SUITE 110
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2303
Country	:	US
Telephone Number	:	616-957-1190
Fax Number	:	616-957-4429

Provider Business Practice Location Address
First Line	:	847 PARCHMENT DR SE
Second Line	:	SUITE 110
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2303
Country	:	US
Telephone Number	:	616-957-1190
Fax Number	:	616-957-4429

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. LORREL A HOP
Credential	:
Telephone Number	:	616-957-1190

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	10/03/2016

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