| Elias Dental Lab | |
|
535 Greenwood Ave Se Ste 100 Grand Rapids MI 49506-2901 | |
| (616) 458-2048 | |
| (616) 458-1311 |
| Full Name | Elias Dental Lab |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 535 Greenwood Ave Se Ste 100, Grand Rapids, Michigan |
| Authorized Official Name and Position | Richard J Elias (DENTIST/OWNER) |
| Authorized Official Contact | 6164582048 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elias Dental Lab 535 Greenwood Ave Se Ste 100 Grand Rapids MI 49506-2901 Ph: (616) 458-2048 | Elias Dental Lab 535 Greenwood Ave Se Ste 100 Grand Rapids MI 49506-2901 Ph: (616) 458-2048 |
| NPI Number | 1720685399 |
|---|---|
| Provider Enumeration Date | 10/06/2020 |
| Last Update Date | 10/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720685399 | NPI | - | NPPES |
| 1093930125 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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