Provider Demographics
NPI:1386415651
Name:MITTEN KIDS ORTHODONTICS PLC
Entity type:Organization
Organization Name:MITTEN KIDS ORTHODONTICS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-942-9840
Mailing Address - Street 1:1179 E PARIS AVE SE STE 130
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3682
Mailing Address - Country:US
Mailing Address - Phone:616-942-9840
Mailing Address - Fax:616-942-9701
Practice Address - Street 1:1179 E PARIS AVE SE STE 130
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3682
Practice Address - Country:US
Practice Address - Phone:616-942-9840
Practice Address - Fax:616-942-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty