Jeffrey Thomas Anderson

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2903603763 Issued in MI

Practice address

12723 N Bellwood Dr Ste 20
Holland, MI 49424-7275

Phone

(616) 377-7333

NPI assigned

Apr 9, 2021

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

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.

• Little Red Pediatric Dentistry, PLC

  • Pediatric Dentistry
  • Holland, MI
  • NPI 1063987725
  NPD (past)
• State University of Iowa

  • Clinical Medical Laboratory
  • Coralville, IA
  • NPI 1851371561
  NPD (past)

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711152000000",
    "number": "1265012785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 RIDGES BND APT 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465437",
            "telephone_number": "419-304-6814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12723 N BELLWOOD DR STE 20",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494247275",
            "telephone_number": "616-377-7333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JEFFREY",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-09",
        "last_updated": "2024-03-23",
        "certification_date": "2024-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2903603763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher David Anderson
• Connie M Anderson, PA-C
• Ellen Anderson
• Jacqueline J Anderson, DDS
• Jami Temple Anderson, PT, DPT, AT, A.T.,C.
• Linda R Anderson, MS PT
• Matthew Anderson, RPH
• Molly Hunter Anderson
• Rebecca Naomi Anderson
• Thomas E Anderson, DDS

• Pediatric Dentistry in Holland, MI
• Providers in Holland, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2024; 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.