Provider Demographics
NPI:1013099092
Name:KAREN A O ROURKE DDS PC
Entity Type:Organization
Organization Name:KAREN A O ROURKE DDS PC
Other - Org Name:KAREN A O ROURKE DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:O ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-455-7930
Mailing Address - Street 1:4250 KALAMAZOO SE STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3607
Mailing Address - Country:US
Mailing Address - Phone:616-455-7930
Mailing Address - Fax:616-455-9952
Practice Address - Street 1:4250 KALAMAZOO SE STE 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3607
Practice Address - Country:US
Practice Address - Phone:616-455-7930
Practice Address - Fax:616-455-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty