Organization
KINGMA PEDIATRIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA MERREN (OFFICE MANAGER)
(616) 551-9701
Entity
Organization
Contact information
Practice address
1179 E PARIS AVE SE STE 130, GRAND RAPIDS, MI 49546-3682
(616) 942-9840
(616) 942-0170
Mailing address
1179 E PARIS AVE SE STE 130, GRAND RAPIDS, MI 49546-3682
(616) 942-9840
(616) 942-0170
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/07/2018
Last updated
11/07/2018
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