NPIMap

Organization Active NPI

Westnedge Family Dentistry

  • General Practice Dentistry
  • Kalamazoo, MI
National Provider Identifier
1013074095
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14741 Issued in MI
Legal business name
WESTNEDGE FAMILY DENTISTRY
Practice address
3907 S Westnedge Ave
Kalamazoo, MI 49008-3187
Phone
(269) 345-8893
Fax
(269) 492-1710
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Charles Sackett, D.D.SNPI 1861616401
Title
Dentist
Phone
(269) 345-8893

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 14741 MI Primary

Addresses

Primary practice location

3907 S Westnedge Ave
Kalamazoo, MI 49008-3187

Mailing address

3907 S Westnedge Ave
Kalamazoo, MI 49008-3187
Phone (269) 345-8893

Other identifiers 8

IdentifierTypeStateIssuer
16115OtherMIMI DELTA DENTAL # JUNGBLU
3273360MedicaidMI
17761OtherMIMASON-DELTA DENTAL MI
2901016115OtherMITIM JUNGBLUT STATE LICENS
2901017761OtherMILICENSE #
2901014741OtherMILICENSE
14741OtherMISACKETT-DELTA DENTAL #
3273324MedicaidMI

National Provider Directory

National Provider Directory

Locations

3907 S Westnedge Ave
Kalamazoo, MI 49008
Phone (269) 345-8893

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013074095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3907 S WESTNEDGE AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490083187",
            "telephone_number": "269-345-8893",
            "fax_number": "269-492-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3907 S WESTNEDGE AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490083187",
            "telephone_number": "269-345-8893",
            "fax_number": "269-492-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTNEDGE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SACKETT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "269-345-8893",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "14741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI DELTA DENTAL # JUNGBLU",
            "identifier": "16115",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3273360",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASON-DELTA DENTAL MI",
            "identifier": "17761",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TIM JUNGBLUT STATE LICENS",
            "identifier": "2901016115",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "2901017761",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2901014741",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SACKETT-DELTA DENTAL #",
            "identifier": "14741",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3273324",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.