Individual provider Active NPI

Kylee Lynn Mandigo, DDS

  • General Practice Dentistry
  • Hudsonville, MI
National Provider Identifier
1104757392
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901602969 Issued in MI
Practice address
3185 Corporate Grove Dr
Hudsonville, MI 49426-8021
Phone
(616) 896-7600
NPI assigned
May 26, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901602969 MI Primary

Addresses

Primary practice location

3185 Corporate Grove Dr
Hudsonville, MI 49426-8021

Mailing address

3185 Corporate Grove Dr
Hudsonville, MI 49426-8021
Phone (616) 896-7600

Other names 1

  • Mrs. Kylee Lynn Austin Other name

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

LicenseStateTypeSpecialty
2901602969MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Hudsonville Dentistry PLLC PastSince Nov 7, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1779753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1104757392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3185 CORPORATE GROVE DR",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494268021",
            "telephone_number": "616-896-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3185 CORPORATE GROVE DR",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494268021",
            "telephone_number": "616-896-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDIGO",
        "first_name": "KYLEE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-05-26",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901602969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLEE",
            "last_name": "AUSTIN",
            "middle_name": "LYNN",
            "prefix": "MRS.",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hudsonville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2026; 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.