Organization
DJ EDGERLE, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEFOE J EDGERLE DDS (OWNER)
(616) 949-2720
Entity
Organization
Contact information
Practice address
751 KENMOOR AVE SE STE G, GRAND RAPIDS, MI 49546-2391
(616) 949-2720
(616) 949-9320
Mailing address
751 KENMOOR AVE SE STE G, GRAND RAPIDS, MI 49546-2391
(616) 949-2720
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/09/2020
Last updated
03/09/2020
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