Organization
GRAPEVINE DENTURE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK D ROSS D.D.S. (DENTIST)
(231) 943-8409
Entity
Organization
Contact information
Practice address
865 US HIGHWAY 31 S, TRAVERSE CITY, MI 49684-8716
(231) 943-8409
Mailing address
865 US HIGHWAY 31 S, TRAVERSE CITY, MI 49684-8716
(231) 943-8409
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
08128
MI
Other
Enumeration date
05/08/2007
Last updated
08/22/2020
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