| NPI | 1336399047 |
|---|---|
| Doing Business As | SCHOOL DENTAL PROGRAM |
| Entity Type | Organization |
| Authorized Contact | TASHA BLACKMON CEO 616-776-2120 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2024-06-25 |