Provider Demographics
NPI:1043430598
Name:GRANDVILLE FAMILY DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:GRANDVILLE FAMILY DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-534-7138
Mailing Address - Street 1:3100 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1200
Mailing Address - Country:US
Mailing Address - Phone:616-534-7138
Mailing Address - Fax:616-534-7174
Practice Address - Street 1:3100 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1200
Practice Address - Country:US
Practice Address - Phone:616-534-7138
Practice Address - Fax:616-534-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty