Eastern Dental PLC

Primary specialty

DentistTaxonomy code 122300000X

License

2901018678 Issued in MI

Legal business name

EASTERN DENTAL PLC

Practice address

2426 Burton St SE
Grand Rapids, MI 49546-4898

Phone

(616) 974-0991

Fax

(616) 974-0920

NPI assigned

Oct 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kourosh B Amiri

Title

Owner/Dentist

Phone

(616) 724-7376

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1033308952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2426 BURTON ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495464898",
            "telephone_number": "616-974-0991",
            "fax_number": "616-974-0920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2426 BURTON ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495464898",
            "telephone_number": "616-974-0991",
            "fax_number": "616-974-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN DENTAL PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "AMIRI",
        "authorized_official_first_name": "KOUROSH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "616-724-7376"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901018678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Paris Pharmacy Inc.
• East Paris Surgical Center, LLC
• Luke Eastburg, MD
• Mark Connar Eastburg, PH.D.
• Eastern Clinic PLLC
• Eastern Door Counseling, LLC
• Eastern Grouphome
• Easterseals Morc Health Care Inc.
• Andrew Eugene Eastham, LMSW
• Paige Eastlick

• Dentist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.