Organization
EASTERN DENTAL PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOUROSH B AMIRI (OWNER/DENTIST)
(616) 724-7376
Entity
Organization
Contact information
Practice address
2426 BURTON ST SE, GRAND RAPIDS, MI 49546-4898
(616) 974-0991
(616) 974-0920
Mailing address
2426 BURTON ST SE, GRAND RAPIDS, MI 49546-4898
(616) 974-0991
(616) 974-0920
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901018678
MI
Other
Enumeration date
10/16/2007
Last updated
06/17/2008
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