ELIAS DENTAL LAB NPI 1720685399

NPI Information

NPI: 1720685399
Provider Name: ELIAS DENTAL LAB
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
535 GREENWOOD AVE SE STE 100
GRAND RAPIDS, MI
ZIP 49506
Phone: (616) 458-2048
Get Directions

ELIAS DENTAL LAB is a dental clinic center in Grand Rapids, MI. ELIAS DENTAL LAB NPI is 1720685399. The provider is registered as an organization entity type.

The provider's business location address is:

535 GREENWOOD AVE SE STE 100
GRAND RAPIDS, MI
ZIP 49506-901
Phone: (616) 458-2048
Fax: (616) 458-1311

The provider's authorized official is Richard J Elias .
The authorized official title is Dentist/owner and has the following contact phone number (616) 458-2048.

The enumeration date for this NPI number is 10/6/2020 and was last updated on 10/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1093930125	MEDICAID	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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