Organization
IVANREST FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LEWIS EGGLESTON II D.D.S. (OWNER)
(616) 538-3060
Entity
Organization
Contact information
Practice address
3100 IVANREST AVE SW, SUITE 105, GRANDVILLE, MI 49418-2955
(616) 538-3060
(616) 538-3653
Mailing address
3100 IVANREST AVE SW, SUITE 105, GRANDVILLE, MI 49418-2955
(616) 538-3060
(616) 538-3653
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901016314
MI
122300000X
Dentist
2901021476
MI
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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