Provider Demographics
NPI:1902827157
Name:HERNLY FAMILY AND COSMETIC DENTISTRY, PC
Entity Type:Organization
Organization Name:HERNLY FAMILY AND COSMETIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-957-1731
Mailing Address - Street 1:847 PARCHMENT DR SE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2303
Mailing Address - Country:US
Mailing Address - Phone:616-957-1731
Mailing Address - Fax:616-957-4420
Practice Address - Street 1:847 PARCHMENT DR SE
Practice Address - Street 2:SUITE 115
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2303
Practice Address - Country:US
Practice Address - Phone:616-957-1731
Practice Address - Fax:616-957-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI180091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty