# JERRY B. MULDER DDS PLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** A Life of Smiles
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841694387
- **Authorized official:** DR. JERRY B MULDER D.D.S (DOCTOR)
- **Authorized official phone:** (616) 458-0631

## Contact information

- **Practice address:** 515 MICHIGAN ST NE STE 202, GRAND RAPIDS, MI 49503-5721
- **Practice address phone:** (616) 458-0631
- **Practice address fax:** (616) 458-4065
- **Mailing address:** 515 MICHIGAN ST NE STE 202, GRAND RAPIDS, MI 49503-5721
- **Mailing address phone:** (616) 458-0631
- **Mailing address fax:** (616) 458-4065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2901012689 | MI | Yes |

## Other

- **Enumeration date:** 10/13/2014
- **Last updated:** 10/22/2014