| Grand Ledge Family Dentistry, Pllc | |
|
416 E River St Grand Ledge MI 48837-1764 | |
| (517) 627-9081 | |
| Not Available |
| Full Name | Grand Ledge Family Dentistry, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 416 E River St, Grand Ledge, Michigan |
| Authorized Official Name and Position | Kyle Mulder (OWNER) |
| Authorized Official Contact | 5178810561 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Ledge Family Dentistry, Pllc 416 E River St Grand Ledge MI 48837-1764 Ph: (517) 627-9081 | Grand Ledge Family Dentistry, Pllc 416 E River St Grand Ledge MI 48837-1764 Ph: (517) 627-9081 |
| NPI Number | 1972199156 |
|---|---|
| Provider Enumeration Date | 12/11/2020 |
| Last Update Date | 12/11/2020 |
| Medicare PECOS PAC ID | 6406269828 |
|---|---|
| Medicare Enrollment ID | O20210104001364 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972199156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Kyle Anthony Mulder |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1881201564 PECOS PAC ID: 5698187490 Enrollment ID: I20210104001436 |
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