Provider Demographics
NPI:1427594027
Name:MEL TROTTER MINISTRIES DENTAL CLINIC
Entity Type:Organization
Organization Name:MEL TROTTER MINISTRIES DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:OOSTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-588-8773
Mailing Address - Street 1:225 COMMERCE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4107
Mailing Address - Country:US
Mailing Address - Phone:616-588-8796
Mailing Address - Fax:
Practice Address - Street 1:225 COMMERCE AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4107
Practice Address - Country:US
Practice Address - Phone:616-588-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty