Provider Demographics
NPI:1619196060
Name:KATHLEEN M. EISIN, DDS MS PLLC
Entity Type:Organization
Organization Name:KATHLEEN M. EISIN, DDS MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EISIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:616-656-0100
Mailing Address - Street 1:6677 CROSSINGS DRIVE SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508
Mailing Address - Country:US
Mailing Address - Phone:616-656-0100
Mailing Address - Fax:616-656-0400
Practice Address - Street 1:6677 CROSSINGS DRIVE SE
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-656-0100
Practice Address - Fax:616-656-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty