Northern Michigan Pediatric Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2901017484 Issued in MI

Legal business name

NORTHERN MICHIGAN PEDIATRIC DENTISTRY

Practice address

4944 Skyview CT
Traverse City, MI 49684-7173

Phone

(231) 947-4566

NPI assigned

Jan 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. James M Van Wingen, DDSNPI 1306998828

Title

Dentist

Phone

(231) 947-4566

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Michael Vanwingen, D.D.S., M.S.

  • Pediatric Dentistry
  • Traverse City, MI
  • NPI 1306998828
  NPD (past) Authorized official
• Matthew Charles Mandeville, DDS

  • Pediatric Dentistry
  • Traverse City, MI
  • NPI 1598812422
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275685265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4944 SKYVIEW CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847173",
            "telephone_number": "231-947-4566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4944 SKYVIEW CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847173",
            "telephone_number": "231-947-4566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MICHIGAN PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAN WINGEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "231-947-4566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": "2901017484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "4457700",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "D158620",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern Michigan Alliance for Independent Living
• Northern Michigan Companions Home Health Care
• Northern Michigan Endoscopic Services PLLC
• Northern Michigan Gastroenterology PLC
• Northern Michigan Medicine and Pediatrics, PLLC
• Northern Michigan Plastic Surgery PC
• Northern Michigan Psychiatric Services
• Northern Michigan Psychiatric Services PC
• Northern Michigan Vascular Center P.C.
• Northern Michigan Vascular Lab PC

• Dental Clinic/Center in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.