Active NPI
Courtney Deruiter, RDH
- Dental Hygienist
- Beaver Island, MI
National Provider Identifier
1306455282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2902019194
- Practice address
- 37304 Kings Hwy
Beaver Island, MI 49782-5134 - Phone
- (231) 547-7650
- NPI assigned
- Jul 28, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902019194 | MI | Primary |
Addresses
Primary practice location
37304 Kings Hwy
Beaver Island, MI 49782-5134
Mailing address
23280 N Rosedale CT
Saint Clair Shores, MI 48080-2615
Phone (313) 549-3822
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2902019194 | MI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595894400000",
"number": "1306455282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23280 N ROSEDALE CT",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480802615",
"telephone_number": "313-549-3822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37304 KINGS HWY",
"city": "BEAVER ISLAND",
"state": "MI",
"postal_code": "497825134",
"telephone_number": "231-547-7650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERUITER",
"first_name": "COURTNEY",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-28",
"last_updated": "2020-07-28",
"certification_date": "2020-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MI",
"license": "2902019194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaver Island, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.