# GRAPEVINE DENTURE SERVICE

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

## Provider details

- **NPI number:** 1902019623
- **Authorized official:** JACK D ROSS D.D.S. (DENTIST)
- **Authorized official phone:** (231) 943-8409

## Contact information

- **Practice address:** 865 US HIGHWAY 31 S, TRAVERSE CITY, MI 49684-8716
- **Practice address phone:** (231) 943-8409
- **Mailing address:** 865 US HIGHWAY 31 S, TRAVERSE CITY, MI 49684-8716
- **Mailing address phone:** (231) 943-8409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 08128 | MI | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 08/22/2020