Grand Ledge Family Dentistry, Pllc | |
416 E River St Grand Ledge MI 48837-1764 | |
(517) 627-9081 | |
Not Available |
Full Name | Grand Ledge Family Dentistry, Pllc |
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Speciality | Dentist |
Location | 416 E River St, Grand Ledge, Michigan |
Authorized Official Name and Position | Kyle Mulder (OWNER) |
Authorized Official Contact | 5178810561 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Grand Ledge Family Dentistry, Pllc 416 E River St Grand Ledge MI 48837-1764 Ph: (517) 627-9081 | Grand Ledge Family Dentistry, Pllc 416 E River St Grand Ledge MI 48837-1764 Ph: (517) 627-9081 |
NPI Number | 1972199156 |
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Provider Enumeration Date | 12/11/2020 |
Last Update Date | 12/11/2020 |
Medicare PECOS PAC ID | 6406269828 |
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Medicare Enrollment ID | O20210104001364 |
Identifier | Type | State | Issuer |
---|---|---|---|
1972199156 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Primary |
Provider Name | Kyle Anthony Mulder |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1881201564 PECOS PAC ID: 5698187490 Enrollment ID: I20210104001436 |
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