Individual
BRANDON J CHURCHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, DDS
Contact information
Practice address
3737 LAKE EASTBROOK BLVD SE STE 212, GRAND RAPIDS, MI 49546-5989
(616) 258-1473
Mailing address
4100 EMBASSY DR SE STE 400, GRAND RAPIDS, MI 49546-2416
(616) 975-1845
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901022201
MI
363A00000X
Physician Assistant
Primary
5691005799
MI
Other
Enumeration date
07/05/2008
Last updated
01/05/2026
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