Michael R. Groen, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

5575 Issued in WA

Practice address

506 Grover St
#108
Lynden, WA 98264-1960

Phone

(360) 354-6036

Fax

(360) 354-5586

NPI assigned

Nov 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

State licenses

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225107956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 GROVER ST",
            "address_2": "#108",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641960",
            "telephone_number": "360-354-6036",
            "fax_number": "360-354-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 GROVER ST",
            "address_2": "#108",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641960",
            "telephone_number": "360-354-6036",
            "fax_number": "360-354-5586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROEN",
        "first_name": "MICHAEL",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "5575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5078001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Global Atlas PLLC
• Karen M Goodman, ARNP
• David Michael Grambo, DPT
• Mary Catherine Green, LM, CPM
• Gregory J. Helgath, Inc. PS (County Orthopedic And Sports Therapy)
• Dawne M Grove, M.C. LMHC
• Lee Haak
• Jolene Marie Haferkorn, LMT
• Doniel M Hagee, DPT
• Omar Tariq Hanjra

• Dentist in Lynden, WA
• Providers in Lynden, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.