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Organization
GLEN VALLEY DENTISTRY
Active
Organization
GLEN VALLEY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN T. VAUGHAN DDS (OWNER/DENTIST)
(616) 891-8931
Entity
Organization
Contact information
Practice address
9041 N RODGERS CT SE, CALEDONIA, MI 49316-7660
(616) 891-8931
(616) 891-9803
Mailing address
9041 N RODGERS CT SE, CALEDONIA, MI 49316-7660
(616) 891-8931
(616) 891-9803
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901014542
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4836800
—
MI
01
—
846910
UNITED CONCORDIA #
MI
01
—
D801041
BCBS OF MI
MI
Enumeration date
06/10/2006
Last updated
04/20/2008
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