| West Michigan Periodontics & Advanced Implant Dentistry | |
|
3145 Prairie St Sw Suite 104 Grandville MI 49418 | |
| (616) 531-1920 | |
| (616) 531-4275 |
| Full Name | West Michigan Periodontics & Advanced Implant Dentistry |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 3145 Prairie St Sw, Grandville, Michigan |
| Authorized Official Name and Position | Brian Lee Cilla (OWNER PRESIDENT) |
| Authorized Official Contact | 6165311920 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Michigan Periodontics & Advanced Implant Dentistry 3145 Prairie St Sw Suite 104 Grandville MI 49418 Ph: (616) 531-1920 | West Michigan Periodontics & Advanced Implant Dentistry 3145 Prairie St Sw Suite 104 Grandville MI 49418 Ph: (616) 531-1920 |
| NPI Number | 1669630489 |
|---|---|
| Provider Enumeration Date | 05/29/2008 |
| Last Update Date | 05/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669630489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 290104700 (Michigan) | Primary |
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