Provider Demographics
NPI:1063987725
Name:LITTLE RED PEDIATRIC DENTISTRY, PLC
Entity type:Organization
Organization Name:LITTLE RED PEDIATRIC DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMMY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:CDA, RDA
Authorized Official - Phone:616-399-8230
Mailing Address - Street 1:12723 N BELLWOOD DR STE 20
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7275
Mailing Address - Country:US
Mailing Address - Phone:616-377-7333
Mailing Address - Fax:616-399-8374
Practice Address - Street 1:12723 N BELLWOOD DR STE 20
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7275
Practice Address - Country:US
Practice Address - Phone:616-377-7333
Practice Address - Fax:616-399-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty