Active NPI
Scott Knurek
- General Practice Dentistry
- Grand Rapids, MI
National Provider Identifier
1184392607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901600953
- Practice address
- 255 Washington St SE
Grand Rapids, MI 49503-4350 - Phone
- (248) 756-4910
- NPI assigned
- Aug 31, 2021
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901600953 | MI | Primary |
Addresses
Primary practice location
255 Washington St SE
Grand Rapids, MI 49503-4350
Mailing address
887 Eaton Dr
South Lyon, MI 48178-1689
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 |
|---|---|---|---|
| 2901600953 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630368000000",
"number": "1184392607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "887 EATON DR",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481781689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 WASHINGTON ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034350",
"telephone_number": "248-756-4910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNUREK",
"first_name": "SCOTT",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-31",
"last_updated": "2021-08-31",
"certification_date": "2021-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901600953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.