Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fuller Avenue Dental Associates

Organization General Practice Dentistry · NPI 1639397615

Fuller Avenue Dental Associates is a General Practice Dentistry in Grand Rapids, Michigan. Licensed in Michigan. Registered with an NPI since 2007.

Licensed in
MI
In the registry since
2007
Specialties on file
2

Practice location Address checks out

2755 Fuller Ave NE
Grand Rapids, MI 49505-3780
Phone: (616) 363-1136
Fax: (616) 363-4345
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 16615 (MI)
General Practice Dentistry Taxonomy 1223G0001X · Licence 10428 (MI)

Record details

NPI number1639397615
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shannon Visscher-Worst — Office Manager · (616) 363-1136
NPI enumeratedApril 23, 2007
Last updated in NPPESAugust 22, 2020
Mailing address2755 Fuller Ave Ne, Grand Rapids, MI 49505-3780

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