Active NPI
Benjamin Bouchard, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Grand Rapids, MI
National Provider Identifier
1215627724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2901602468
- Practice address
- 3989 Cascade Rd SE
Grand Rapids, MI 49546-2178 - Phone
- (616) 459-7171
- Fax
- (616) 459-7181
- NPI assigned
- May 9, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901602468 | MI | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2901602468 | MI | Primary |
Addresses
Primary practice location
3989 Cascade Rd SE
Grand Rapids, MI 49546-2178
Mailing address
3989 Cascade Rd SE
Grand Rapids, MI 49546-2178
Phone (616) 459-7171
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 |
|---|---|---|---|
| 2901602468 | MI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758499200000",
"number": "1215627724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3989 CASCADE RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462178",
"telephone_number": "616-459-7171",
"fax_number": "616-459-7181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3989 CASCADE RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462178",
"telephone_number": "616-459-7171",
"fax_number": "616-459-7181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHARD",
"first_name": "BENJAMIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-09",
"last_updated": "2025-09-22",
"certification_date": "2025-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901602468",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MI",
"license": "2901602468",
"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 Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.