Organization
MITTEN KIDS DENTISTRY CALEDONIA PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRADY RANDALL DDS (OWNER)
(616) 942-9840
Entity
Organization
Contact information
Practice address
6477 CHERRY MEADOW DR SE STE 4, CALEDONIA, MI 49316-7351
(616) 942-9840
Mailing address
1179 E PARIS AVE SE STE 130, GRAND RAPIDS, MI 49546-3682
(616) 552-9701
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
04/18/2019
Last updated
04/18/2019
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