Provider Demographics
NPI:1346855665
Name:KENTWOOD FAMILY DENTAL CARE, PLC
Entity Type:Organization
Organization Name:KENTWOOD FAMILY DENTAL CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-437-5581
Mailing Address - Street 1:4611 N BRETON CT SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5211
Mailing Address - Country:US
Mailing Address - Phone:616-612-1176
Mailing Address - Fax:
Practice Address - Street 1:4611 N BRETON CT SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5211
Practice Address - Country:US
Practice Address - Phone:616-612-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental