DJ Edgerle, DDS, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DJ EDGERLE, DDS, PC

Practice address

751 Kenmoor Ave SE Ste G
Grand Rapids, MI 49546-2391

Phone

(616) 949-2720

Fax

(616) 949-9320

NPI assigned

Mar 9, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Defoe J Edgerle, DDSNPI 1174684120

Title

Owner

Phone

(616) 949-2720

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Defoe James Edgerle, D.D.S.

  • General Practice Dentistry
  • Grand Rapids, MI
  • NPI 1174684120
  NPD (past) Authorized official

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1295360428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 KENMOOR AVE SE STE G",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462391",
            "telephone_number": "616-949-2720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 KENMOOR AVE SE STE G",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462391",
            "telephone_number": "616-949-2720",
            "fax_number": "616-949-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DJ EDGERLE, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "EDGERLE",
        "authorized_official_first_name": "DEFOE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-949-2720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janelle Dixon
• Jenelle Marie Dixon
• Jodie M Dixon, PT
• Mercy Natasha-Naisenya Dixon, MD
• Alma Dizdarevic, DO
• Mounir Djemil, MD
• Emina Djonko Little, LPC
• Daniel D. DO-Dai, M.D.
• Mai Thi DO
• Viet Huu DO, M.D.

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.