# MATTSON DENTAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bander Dental Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437740313
- **Authorized official:** CARMEN BOLLINGER (PRACTICE MANAGER)
- **Authorized official phone:** (616) 706-7637

## Contact information

- **Practice address:** 1151 E PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-8369
- **Practice address phone:** (616) 949-5980
- **Mailing address:** 1151 E PARIS AVE SE STE 100, GRAND RAPIDS, MI 49546-8369
- **Mailing address phone:** (616) 949-5980

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 332BC3200X | Customized Equipment (DME) | — | — | — |

## Other

- **Enumeration date:** 02/02/2021
- **Last updated:** 07/18/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1710240007 | — | MI |