Provider Demographics
NPI:1841974847
Name:NORTHPOINTE DENTAL AND IMPLANT CENTER OF WYOMING PLLC
Entity type:Organization
Organization Name:NORTHPOINTE DENTAL AND IMPLANT CENTER OF WYOMING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:SUK JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-334-6500
Mailing Address - Street 1:5601 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9353
Mailing Address - Country:US
Mailing Address - Phone:616-334-6500
Mailing Address - Fax:
Practice Address - Street 1:680 3 MILE RD NW STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8218
Practice Address - Country:US
Practice Address - Phone:616-288-6134
Practice Address - Fax:616-825-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental