Individual
DR. MATTHEW P. DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2700 5 MILE RD NE, STE. #201, GRAND RAPIDS, MI 49525-1710
(616) 361-1727
(616) 361-1455
Mailing address
2700 5 MILE NERD 201, GRAND RAPIDS, MI 49525-6516
(616) 361-1727
(616) 361-0060
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
290107668
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4361190
—
MI
Enumeration date
01/23/2007
Last updated
12/08/2015
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