Provider Demographics
NPI:1083223556
Name:GARVIN FAMILY DENTAL CARE, PC
Entity Type:Organization
Organization Name:GARVIN FAMILY DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-878-1514
Mailing Address - Street 1:1420 84TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9344
Mailing Address - Country:US
Mailing Address - Phone:616-878-1514
Mailing Address - Fax:616-878-4014
Practice Address - Street 1:1420 84TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9344
Practice Address - Country:US
Practice Address - Phone:616-878-1514
Practice Address - Fax:616-878-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVS0014967Medicaid