| Ivanrest Family Dentistry | |
|
3100 Ivanrest Ave Sw Suite 105 Grandville MI 49418-2955 | |
| (616) 538-3060 | |
| (616) 538-3653 |
| Full Name | Ivanrest Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 3100 Ivanrest Ave Sw, Grandville, Michigan |
| Authorized Official Name and Position | Robert Lewis Eggleston (OWNER) |
| Authorized Official Contact | 6165383060 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivanrest Family Dentistry 3100 Ivanrest Ave Sw Suite 105 Grandville MI 49418-2955 Ph: (616) 538-3060 | Ivanrest Family Dentistry 3100 Ivanrest Ave Sw Suite 105 Grandville MI 49418-2955 Ph: (616) 538-3060 |
| NPI Number | 1215483284 |
|---|---|
| Provider Enumeration Date | 08/30/2016 |
| Last Update Date | 08/30/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215483284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901016314 (Michigan) | Primary |
| 122300000X | Dentist | 2901021476 (Michigan) | Secondary |
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