# SEVA DENTAL MICHIGAN PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grandville Dental Team
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376390773
- **Authorized official:** KELLY ROLNICKI (DIRECTOR OF REVENUE CYCLE)
- **Authorized official phone:** (708) 372-4773

## Contact information

- **Practice address:** 3100 WILSON AVE SW STE 3, GRANDVILLE, MI 49418-1200
- **Practice address phone:** (616) 534-7138
- **Mailing address:** 19518 LANCASTER DR, MOKENA, IL 60448-7838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 05/02/2024
- **Last updated:** 05/02/2024