# GRANDVILLE DENTAL HEALTH CENTER PC

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

## Provider details

- **NPI number:** 1881843878
- **Authorized official:** LARISSA KYLE BISHOP D.D.S. (PRESIDENT)
- **Authorized official phone:** (616) 531-0360

## Contact information

- **Practice address:** 4050 DEL MAR DR SW, SUITE B, WYOMING, MI 49418-8870
- **Practice address phone:** (616) 531-0360
- **Practice address fax:** (616) 531-2810
- **Mailing address:** 4050 DEL MAR DR SW, SUITE B, WYOMING, MI 49418-8870
- **Mailing address phone:** (616) 531-0360
- **Mailing address fax:** (616) 531-2810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901019378 | MI | Yes |

## Other

- **Enumeration date:** 09/15/2008
- **Last updated:** 01/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4487030 | — | MI |