Provider Demographics
NPI:1457465643
Name:AFENDOULIS, BESSIE E (DDS)
Entity Type:Individual
Prefix:
First Name:BESSIE
Middle Name:E
Last Name:AFENDOULIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 WEALTHY S.E.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2931
Mailing Address - Country:US
Mailing Address - Phone:616-454-8228
Mailing Address - Fax:616-454-8968
Practice Address - Street 1:2249 WEALTHY S.E.
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2931
Practice Address - Country:US
Practice Address - Phone:616-454-8228
Practice Address - Fax:616-454-8968
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0139421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice