Individual
DR. MARK JOHN WIERENGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
3131 44TH ST SW, GRANDVILLE, MI 49418-2684
(616) 301-8900
Mailing address
4421 PENNY LN SW, WYOMING, MI 49418-9383
(616) 862-8202
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2901020872
MI
Other
Enumeration date
05/16/2022
Last updated
05/16/2022
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