Georgetown Family & Cosmetic Dentistry PLC
Organization Active NPI General Practice Dentistry · Jenison, MI
NPI 1255404992 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1255404992
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- GEORGETOWN FAMILY & COSMETIC DENTISTRY PLC
- Practice address
- 7678 Cottonwood Dr
Jenison, MI 49428 - Phone
- (616) 457-4600
- Fax
- (616) 457-4600
- NPI assigned
- Nov 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Tyler Andrew Wolf, DDS
- Title
- Owner Dentist
- Phone
- (616) 457-4600
Practitioners 2
-
Tyler Andrew Wolf, DDS
-
John Paul Klooster, DDS
National Provider Directory
Locations
7678 Cottonwood Dr
Jenison, MI 49428
Phone (616) 457-4600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
7678 Cottonwood Dr
Jenison, MI 49428
Mailing address
7678 Cottonwood Dr
Jenison, MI 49428
Phone (616) 457-4600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J801114 | Other | BCBS ID # |
Other providers in Jenison, MI
- Nicole Fryling
- Gregory Gardner
- Philip Gastineau
- Katie Irene Gendron
- Georgetown Chiropractic
- Georgetown Medical Center LLC
- Mary Elizabeth Getz
- Peyton Goch
- Susan Elizabeth Gordon-Arntson
- Sarah Anne Sainem Gordon
All providers in Jenison, MI · General Practice Dentistry in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.