Provider Demographics
NPI:1568599660
Name:GRAND VALLEY DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:GRAND VALLEY DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-245-2767
Mailing Address - Street 1:2020 DIVISION AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3029
Mailing Address - Country:US
Mailing Address - Phone:616-245-2767
Mailing Address - Fax:616-245-0498
Practice Address - Street 1:2020 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3029
Practice Address - Country:US
Practice Address - Phone:616-245-2767
Practice Address - Fax:616-245-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI082821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty