Organization
GEORGETOWN FAMILY & COSMETIC DENTISTRY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER ANDREW WOLF DDS (OWNER DENTIST)
(616) 457-4600
Entity
Organization
Contact information
Practice address
7678 COTTONWOOD DR, JENISON, MI 49428
(616) 457-4600
(616) 457-4600
Mailing address
7678 COTTONWOOD DR, JENISON, MI 49428
(616) 457-4600
(616) 457-6021
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J801114
BCBS ID #
—
Enumeration date
11/17/2006
Last updated
08/22/2020
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