Provider Demographics
NPI:1942281480
Name:EAST PARIS DENTAL PROFESSIONALS PLC
Entity Type:Organization
Organization Name:EAST PARIS DENTAL PROFESSIONALS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-949-7290
Mailing Address - Street 1:2060 E PARIS AVE SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6501
Mailing Address - Country:US
Mailing Address - Phone:616-949-7290
Mailing Address - Fax:616-949-6108
Practice Address - Street 1:2060 E PARIS AVE SE
Practice Address - Street 2:SUITE 210
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6501
Practice Address - Country:US
Practice Address - Phone:616-949-7290
Practice Address - Fax:616-949-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty