616 Dental Studio PLLC
Dentist in Grand Rapids, MI. Organization (NPI-2).
NPI number1720413636
StatusActive
Last updated in NPPESSep 10, 2013
Details
- NPI
- 1720413636
- Entity type
- Organization (NPI-2)
- Legal business name
- 616 Dental Studio PLLC
- Organization subpart
- No
- Enumeration date
- Sep 10, 2013
- Last updated
- Sep 10, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 2901020846 | MI | Yes |
Practice location
171 Monroe Ave NwGrand Rapids, MI 49503-2634
Phone 616-214-7865
Mailing address
171 Monroe Ave NwGrand Rapids, MI 49503-2634
Phone 616-214-7865
Authorized official
Marcos Cid
Dentist
6162147865
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