Individual provider Active NPI

Jeremy Norman Dzingle, D.M.D.

  • General Practice Dentistry
  • Rockford, MI
National Provider Identifier
1376793307
Registry record updated Jul 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901019900 Issued in MI
Practice address
4655 14 Mile Rd NE
Rockford, MI 49341-7308
Phone
(616) 263-9207
NPI assigned
Sep 26, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901019900 MI Primary

Addresses

Primary practice location

4655 14 Mile Rd NE
Rockford, MI 49341-7308

Mailing address

4655 14 Mile Rd NE
Rockford, MI 49341-7308
Phone (616) 263-9207

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161013002207 MI Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 8022306687

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901019900MIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1376793307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 14 MILE RD NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493417308",
            "telephone_number": "616-263-9207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 14 MILE RD NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493417308",
            "telephone_number": "616-263-9207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZINGLE",
        "first_name": "JEREMY",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-26",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

Verify at the official NPI Registry.