Organization
COUNTY OF KENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BAKOS (FINANCE SUPERVISOR)
(616) 632-7244
Entity
Organization
Contact information
Practice address
700 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 632-7120
(616) 632-7083
Mailing address
700 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 632-7120
(616) 632-7083
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
261QD0000X
Dental Clinic/Center
2901020199
MI
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1845806
—
MI
05
—
2674614
—
MI
05
—
4529013
—
MI
Enumeration date
03/07/2007
Last updated
02/28/2018
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