Provider Demographics
NPI:1447995261
Name:3 MILE FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:3 MILE FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASA
Authorized Official - Middle Name:
Authorized Official - Last Name:URUKALO-HARSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-784-4038
Mailing Address - Street 1:976 3 MILE RD NW STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8203
Mailing Address - Country:US
Mailing Address - Phone:616-784-4038
Mailing Address - Fax:
Practice Address - Street 1:976 3 MILE RD NW STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8203
Practice Address - Country:US
Practice Address - Phone:616-784-4038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental