| 44 West Dental Professionals Pc | |
|
4330 44th St Sw Ste 105 Grandville MI 49418-2349 | |
| (616) 530-2200 | |
| (616) 530-8250 |
| Full Name | 44 West Dental Professionals Pc |
|---|---|
| Speciality | Dentist |
| Location | 4330 44th St Sw Ste 105, Grandville, Michigan |
| Authorized Official Name and Position | Jason C Doublestein (CO-OWNER) |
| Authorized Official Contact | 6165302200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 44 West Dental Professionals Pc 4330 44th St Sw Ste 105 Grandville MI 49418-2349 Ph: (616) 530-2200 | 44 West Dental Professionals Pc 4330 44th St Sw Ste 105 Grandville MI 49418-2349 Ph: (616) 530-2200 |
| NPI Number | 1275914673 |
|---|---|
| Provider Enumeration Date | 06/11/2015 |
| Last Update Date | 10/09/2019 |
| Medicare PECOS PAC ID | 0446684286 |
|---|---|
| Medicare Enrollment ID | O20200102001400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275914673 | NPI | - | NPPES |
| 1386760072 | Other | MI | DENTIST |
| 1760829444 | Other | MI | DENTIST |
| 1578823993 | Other | MI | DENTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901018806 (Michigan) | Primary |
| 122300000X | Dentist | 2901020644 (Michigan) | Secondary |
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