Provider Demographics
NPI:1881912491
Name:GRANDVIEW DENTAL CARE PLLC
Entity type:Organization
Organization Name:GRANDVIEW DENTAL CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:231-922-0775
Mailing Address - Street 1:421 2ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2004
Mailing Address - Country:US
Mailing Address - Phone:231-922-0775
Mailing Address - Fax:231-941-1831
Practice Address - Street 1:421 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2004
Practice Address - Country:US
Practice Address - Phone:231-922-0775
Practice Address - Fax:231-941-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI151391223G0001X
MI29010151391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty