Provider Demographics
NPI:1932366275
Name:DENTAL EXPRESSIONS
Entity type:Organization
Organization Name:DENTAL EXPRESSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAROU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-956-0292
Mailing Address - Street 1:6809 CASCADE RD SE
Mailing Address - Street 2:STE E
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6895
Mailing Address - Country:US
Mailing Address - Phone:616-956-0292
Mailing Address - Fax:616-956-3251
Practice Address - Street 1:6809 CASCADE RD SE
Practice Address - Street 2:STE E
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6895
Practice Address - Country:US
Practice Address - Phone:616-956-0292
Practice Address - Fax:616-956-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty