Provider Demographics
NPI:1962855163
Name:LELAND D. ZUIDEMA DDS P.C.
Entity Type:Organization
Organization Name:LELAND D. ZUIDEMA DDS P.C.
Other - Org Name:ZUIDEMA & HESS FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-656-2400
Mailing Address - Street 1:6677 CROSSINGS DR SE
Mailing Address - Street 2:STE #1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7889
Mailing Address - Country:US
Mailing Address - Phone:616-656-2400
Mailing Address - Fax:616-656-2424
Practice Address - Street 1:6677 CROSSINGS DR SE
Practice Address - Street 2:STE #1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7889
Practice Address - Country:US
Practice Address - Phone:616-656-2400
Practice Address - Fax:616-656-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty