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Organization
MATTSON DENTAL, PLLC
Active
Organization
MATTSON DENTAL, PLLC
Active
Other names
Bander Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN BOLLINGER (PRACTICE MANAGER)
(616) 706-7637
Entity
Organization
Contact information
Practice address
1151 E PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-8369
(616) 949-5980
Mailing address
1151 E PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-8369
(616) 949-5980
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710240007
—
MI
Enumeration date
02/02/2021
Last updated
07/18/2024
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