Provider Demographics
NPI:1427002377
Name:DALRYMPLE, DAVID R (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:DALRYMPLE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 3 MILE RD NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8207
Mailing Address - Country:US
Mailing Address - Phone:616-785-1700
Mailing Address - Fax:616-785-1701
Practice Address - Street 1:550 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8207
Practice Address - Country:US
Practice Address - Phone:616-785-1700
Practice Address - Fax:616-785-1701
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL7364101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4752157Medicaid
MIN79070001Medicare PIN