Provider Demographics
NPI:1699275909
Name:GREENVILLE FAMILY DENTAL, PLC
Entity type:Organization
Organization Name:GREENVILLE FAMILY DENTAL, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEACHUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-754-8631
Mailing Address - Street 1:1717 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2625
Mailing Address - Country:US
Mailing Address - Phone:616-754-8631
Mailing Address - Fax:
Practice Address - Street 1:1717 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2625
Practice Address - Country:US
Practice Address - Phone:616-754-8631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty