Provider Demographics
NPI:1538250907
Name:KENT FAMILY DENTAL CARE
Entity type:Organization
Organization Name:KENT FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STACHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-364-9348
Mailing Address - Street 1:7604 WOODVALE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-9147
Mailing Address - Country:US
Mailing Address - Phone:616-364-9348
Mailing Address - Fax:616-364-5950
Practice Address - Street 1:2515 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1924
Practice Address - Country:US
Practice Address - Phone:616-364-9348
Practice Address - Fax:616-364-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty