Active NPI
Jacob Williams, D.D.S.
- Dentist
- Grand Ledge, MI
National Provider Identifier
1063896918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901021607
- Practice address
- 100 Bouck Ave
Grand Ledge, MI 48837-1606 - Phone
- (517) 256-9840
- NPI assigned
- Jul 9, 2015
- Last updated
- Jul 9, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901021607 | MI | Primary |
Addresses
Primary practice location
100 Bouck Ave
Grand Ledge, MI 48837-1606
Mailing address
100 Bouck Ave
Grand Ledge, MI 48837-1606
Phone (517) 256-9840
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901021607 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436400000000",
"number": "1063896918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BOUCK AVE",
"city": "GRAND LEDGE",
"state": "MI",
"postal_code": "488371606",
"telephone_number": "517-256-9840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BOUCK AVE",
"city": "GRAND LEDGE",
"state": "MI",
"postal_code": "488371606",
"telephone_number": "517-256-9840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JACOB",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-09",
"last_updated": "2015-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901021607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Ledge, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.