| Glen Valley Dentistry | |
|
9041 N Rodgers Ct Se Caledonia MI 49316-7660 | |
| (616) 891-8931 | |
| (616) 891-9803 |
| Full Name | Glen Valley Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9041 N Rodgers Ct Se, Caledonia, Michigan |
| Authorized Official Name and Position | Robin T. Vaughan (OWNER/DENTIST) |
| Authorized Official Contact | 6168918931 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glen Valley Dentistry 9041 N Rodgers Ct Se Caledonia MI 49316-7660 Ph: (616) 891-8931 | Glen Valley Dentistry 9041 N Rodgers Ct Se Caledonia MI 49316-7660 Ph: (616) 891-8931 |
| NPI Number | 1538100482 |
|---|---|
| Provider Enumeration Date | 06/10/2006 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538100482 | NPI | - | NPPES |
| D801041 | Other | MI | BCBS OF MI |
| 846910 | Other | MI | UNITED CONCORDIA # |
| 4836800 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2901014542 (Michigan) | Primary |
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