Provider Demographics
NPI:1023414695
Name:APPLE DENTURE CENTER OF WEST MICHIGAN
Entity type:Organization
Organization Name:APPLE DENTURE CENTER OF WEST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-799-1110
Mailing Address - Street 1:900 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3770
Mailing Address - Country:US
Mailing Address - Phone:231-773-8500
Mailing Address - Fax:231-773-1314
Practice Address - Street 1:900 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3770
Practice Address - Country:US
Practice Address - Phone:231-773-8500
Practice Address - Fax:231-773-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty