Jerry Burgess Mulder Jr., DDS PLC

Primary specialty

DentistTaxonomy code 122300000X

License

D126890 Issued in MI

Practice address

515 Michigan St NE
Suite 202
Grand Rapids, MI 49503-5721

Phone

(616) 458-0631

Fax

(616) 458-4065

NPI assigned

Mar 23, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Jerry B. Mulder DDS PLC

  • General Practice Dentistry
  • Grand Rapids, MI
  • NPI 1841694387
  NPD Authorized official
• Jerry Burgess Mulder

  • Durable Medical Equipment & Medical Supplies
  • Grand Rapids, MI
  • NPI 1962830794
  NPD Authorized official

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436313600000",
    "number": "1104943398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 MICHIGAN ST",
            "address_2": "SUITE 202",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-458-0631",
            "fax_number": "616-458-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MICHIGAN ST NE",
            "address_2": "SUITE 202",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035721",
            "telephone_number": "616-458-0631",
            "fax_number": "616-458-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULDER",
        "first_name": "JERRY",
        "middle_name": "BURGESS",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS PLC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2015-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "D126890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian A Mulder, D.D.S.
• Brian James Mulder, LPC
• Cheryl Mulder, BS
• Courtney Joy Mulder, NP
• Helen Mulder, OT
• John J Mulder IV, PA-C
• Jonathan Mulder
• Kenneth J Mulder, DDS,MS
• Monica Mulder, NP
• Ruth Elinor Mulder, CNM

• All providers in Grand Rapids, MI
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.