| Modern Periodontics | |
|
2356 32nd Street Suite #100 Grand Rapids MI 49508-1510 | |
| (616) 241-5658 | |
| Not Available |
| Full Name | Modern Periodontics |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 2356 32nd Street, Grand Rapids, Michigan |
| Authorized Official Name and Position | Erin Nicole Moerdyke (OFFICE MANAGER) |
| Authorized Official Contact | 6162415658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Periodontics 2356 32nd Street Suite #100 Grand Rapids MI 49508 Ph: (616) 241-5658 | Modern Periodontics 2356 32nd Street Suite #100 Grand Rapids MI 49508-1510 Ph: (616) 241-5658 |
| NPI Number | 1679855761 |
|---|---|
| Provider Enumeration Date | 09/14/2011 |
| Last Update Date | 09/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679855761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 16791 (Michigan) | Primary |
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