# STUART PETTIJOHN DDS PLLC

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

## Provider details

- **NPI number:** 1295254035
- **Authorized official:** DR. STUART PETTIJOHN DDS (DENTIST)
- **Authorized official phone:** (616) 890-0750

## Contact information

- **Practice address:** 4500 CASCADE RD SE STE 100, GRAND RAPIDS, MI 49546-3665
- **Practice address phone:** (616) 942-8301
- **Mailing address:** 4500 CASCADE RD SE STE 100, GRAND RAPIDS, MI 49546-3665
- **Mailing address phone:** (616) 942-8301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901020216 | MI | Yes |

## Other

- **Enumeration date:** 09/13/2017
- **Last updated:** 07/21/2022