Organization
GRANDVILLE DENTAL HEALTH CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA KYLE BISHOP D.D.S. (PRESIDENT)
(616) 531-0360
Entity
Organization
Contact information
Practice address
4050 DEL MAR DR SW, SUITE B, WYOMING, MI 49418-8870
(616) 531-0360
(616) 531-2810
Mailing address
4050 DEL MAR DR SW, SUITE B, WYOMING, MI 49418-8870
(616) 531-0360
(616) 531-2810
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901019378
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4487030
—
MI
Enumeration date
09/15/2008
Last updated
01/23/2013
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