Provider Demographics
NPI:1750569323
Name:GEORGE A CRIPPS DDS PC
Entity type:Organization
Organization Name:GEORGE A CRIPPS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-455-7310
Mailing Address - Street 1:6714 DIVISION AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7808
Mailing Address - Country:US
Mailing Address - Phone:616-455-7310
Mailing Address - Fax:616-455-0332
Practice Address - Street 1:6714 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-7808
Practice Address - Country:US
Practice Address - Phone:616-455-7310
Practice Address - Fax:616-455-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9406261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4018095Medicaid