Organization
FULLER AVENUE DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON MARIE VISSCHER-WORST (OFFICE MANAGER)
(616) 363-1136
Entity
Organization
Contact information
Practice address
2755 FULLER AVE NE, GRAND RAPIDS, MI 49505-3780
(616) 363-1136
(616) 363-4345
Mailing address
2755 FULLER AVE NE, GRAND RAPIDS, MI 49505-3780
(616) 363-1136
(616) 363-4345
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
10428
MI
1223G0001X
General Practice Dentistry
Primary
16615
MI
Other
Enumeration date
04/23/2007
Last updated
08/22/2020
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