Jennifer Ann White, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901019404 Issued in MI

Practice address

113 E 7TH Street
PO Box 310
Manton, MI 49663

Phone

(231) 824-3711

Fax

(231) 824-3035

NPI assigned

Dec 1, 2006

Sex

Female

Sole proprietor

No

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.

• Professional Dental Associates PC

  • General Practice Dentistry
  • Big Rapids, MI
  • NPI 1992863401

  General Practice

  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 10, 2024.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1164590691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 E 7TH STREET",
            "address_2": "PO BOX",
            "city": "MANTON",
            "state": "MI",
            "postal_code": "49663",
            "telephone_number": "231-824-3711",
            "fax_number": "231-824-3711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 E 7TH STREET",
            "address_2": "PO BOX 310",
            "city": "MANTON",
            "state": "MI",
            "postal_code": "49663",
            "telephone_number": "231-824-3711",
            "fax_number": "231-824-3035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2024-06-10",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019404",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1883238",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "D194040",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristina Lynn Raymer I
• Chris Edward Ritter, DDS
• Nicole Danielle Schaub
• Mary Schmidt
• Hilda Schut

• All providers in Manton, MI
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.