Organization
WEST MICHIGAN PEDIATRIC DENTISTRY
Active
Other names
West Michigan Pedatric Dentistry, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY WISSINK (OFFICE MANAGER)
(616) 392-2381
Entity
Organization
Contact information
Practice address
845 E. 16TH ST, HOLLAND, MI 49423
(616) 392-2381
(616) 392-3748
Mailing address
845 E. 16TH ST, HOLLAND, MI 49423
(616) 392-2381
(616) 392-3748
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2901012323
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4383590-12
—
MI
05
—
4383607-12
—
MI
Enumeration date
03/23/2007
Last updated
09/24/2021
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