Individual
DEFOE JAMES EDGERLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
751 KENMOOR AVE SE, SUITE G, GRAND RAPIDS, MI 49546-2388
(616) 949-4272
(616) 949-9320
Mailing address
751 KENMOOR AVE SE, SUITE G, GRAND RAPIDS, MI 49546-2388
(616) 949-4272
(616) 949-9320
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
015945
MI
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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