# MARK W. TOURNELL, D.D.S., PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285060780
- **Authorized official:** DR. MARK TOURNELL D.D.S. (OWNER)
- **Authorized official phone:** (616) 942-0840

## Contact information

- **Practice address:** 5010 CASCADE RD SE, GRAND RAPIDS, MI 49546-3725
- **Practice address phone:** (616) 942-0840
- **Mailing address:** 5010 CASCADE RD SE, GRAND RAPIDS, MI 49546-3725

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | J11639 | MI | Yes |

## Other

- **Enumeration date:** 09/17/2013
- **Last updated:** 04/13/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1275520199 | NPI TYPE 1 | MI |