| School Dental Program | |
|
101 Sheldon Blvd Se Grand Rapids MI 49503-4262 | |
| (616) 776-2363 | |
| Not Available |
| Full Name | School Dental Program |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 101 Sheldon Blvd Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Tasha Blackmon (CEO) |
| Authorized Official Contact | 6167762120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| School Dental Program 100 Cherry St Se Grand Rapids MI 49503-4526 Ph: (616) 965-8200 | School Dental Program 101 Sheldon Blvd Se Grand Rapids MI 49503-4262 Ph: (616) 776-2363 |
| NPI Number | 1336399047 |
|---|---|
| Provider Enumeration Date | 09/30/2008 |
| Last Update Date | 06/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336399047 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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