Provider Demographics
NPI:1194421909
Name:AFFINITY DENTAL CARE PLC
Entity type:Organization
Organization Name:AFFINITY DENTAL CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:404-207-2605
Mailing Address - Street 1:PO BOX 141547
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49514-1547
Mailing Address - Country:US
Mailing Address - Phone:404-207-2605
Mailing Address - Fax:
Practice Address - Street 1:2807 LAKE MICHIGAN DR NW STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5831
Practice Address - Country:US
Practice Address - Phone:678-462-0499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1629497631OtherNPPES