# GRAND RIVER ENDODONTICS PC

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

## Provider details

- **NPI number:** 1518360304
- **Authorized official:** DR. SARAH LENNAN MASTERSON DDS, MSD (OWNER/ENDODONTIST)
- **Authorized official phone:** (616) 249-3500

## Contact information

- **Practice address:** 4211 PARKWAY PLACE DR SW, SUITE 104, GRANDVILLE, MI 49418-2695
- **Practice address phone:** (616) 249-3500
- **Practice address fax:** (616) 249-3502
- **Mailing address:** 4211 PARKWAY PLACE DR SW, SUITE 104, GRANDVILLE, MI 49418-2695
- **Mailing address phone:** (616) 249-3500
- **Mailing address fax:** (616) 249-3502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 2901019457 | MI | Yes |

## Other

- **Enumeration date:** 10/07/2014
- **Last updated:** 09/30/2017