Organization
GRAND RIVER ORTHODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER GIETZEN (PRESIDENT/ORTHODONTIST)
(616) 879-0200
Entity
Organization
Contact information
Practice address
1335 W MAIN ST, SUITE D, LOWELL, MI 49331-1555
(616) 897-0200
Mailing address
1335 W MAIN ST, SUITE D, LOWELL, MI 49331-1555
(616) 897-0200
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2901018802
MI
Other
Enumeration date
11/18/2010
Last updated
11/18/2010
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