Organization
ELIAS DENTAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J ELIAS DDS (DENTIST/OWNER)
(616) 458-2048
Entity
Organization
Contact information
Practice address
535 GREENWOOD AVE SE STE 100, GRAND RAPIDS, MI 49506-2901
(616) 458-2048
(616) 458-1311
Mailing address
535 GREENWOOD AVE SE STE 100, GRAND RAPIDS, MI 49506-2901
(616) 458-2048
(616) 458-1311
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093930125
—
MI
Enumeration date
10/06/2020
Last updated
10/06/2020
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