| Dj Edgerle, Dds, Pc | |
|
751 Kenmoor Ave Se Ste G Grand Rapids MI 49546-2391 | |
| (616) 949-2720 | |
| (616) 949-9320 |
| Full Name | Dj Edgerle, Dds, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 751 Kenmoor Ave Se Ste G, Grand Rapids, Michigan |
| Authorized Official Name and Position | Defoe J Edgerle (OWNER) |
| Authorized Official Contact | 6169492720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dj Edgerle, Dds, Pc 751 Kenmoor Ave Se Ste G Grand Rapids MI 49546-2391 Ph: (616) 949-2720 | Dj Edgerle, Dds, Pc 751 Kenmoor Ave Se Ste G Grand Rapids MI 49546-2391 Ph: (616) 949-2720 |
| NPI Number | 1295360428 |
|---|---|
| Provider Enumeration Date | 03/09/2020 |
| Last Update Date | 03/09/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295360428 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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