Katherine Vander Wal, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901020013 Issued in MI

Practice address

7706 Georgetown Center Dr
Jenison, MI 49428-7144

Phone

(616) 855-0005

NPI assigned

Dec 8, 2011

Sex

Female

Sole proprietor

Yes

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.

• Holly G. Aylworth D.D.S.

  • General Practice Dentistry
  • Jenison, MI
  • NPI 1871611152
  NPD (past)

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1265700025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3519 CITY RIDGE CT",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494267735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7706 GEORGETOWN CENTER DR",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494287144",
            "telephone_number": "616-855-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER WAL",
        "first_name": "KATHERINE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-08",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Lawrence Tuttle, MA, MED, LPC
• Jessica Uzarski
• Nicole Van Allen Horne, M.D.
• Cassidy Van Dyke
• Rachel Vanbeek
• Anita Maria Vanderstelt, D.O.
• Regan Vanderveen
• Grace Vanderwerf
• Kelly Marie Vandyke, LMSW
• Janine Vannoord, MD

• Dentist in Jenison, MI
• Providers in Jenison, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; 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.