Provider Demographics
NPI:1720537764
Name:PARCHMENT FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:PARCHMENT FAMILY DENTISTRY, LLC
Other - Org Name:NORTHWAY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORREL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-957-1190
Mailing Address - Street 1:847 PARCHMENT DR SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2303
Mailing Address - Country:US
Mailing Address - Phone:616-957-1190
Mailing Address - Fax:616-957-4429
Practice Address - Street 1:847 PARCHMENT DR SE
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2303
Practice Address - Country:US
Practice Address - Phone:616-957-1190
Practice Address - Fax:616-957-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty