Kathleen Marie Eisin, D.D.S, M.S.,PLLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

2901018765 Issued in MI

Practice address

6677 Crossings Drive SE
Suite #3
Grand Rapids, MI 49508

Phone

(616) 656-0100

Fax

(616) 656-0400

NPI assigned

Jan 30, 2007

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)

Enrolled

Credentials

Master of Science

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.

• Kathleen M. Eisin, DDS Ms PLLC

  • Periodontics
  • Grand Rapids, MI
  • NPI 1619196060
  NPD (past) Authorized official

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386780666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6677 CROSSINGS DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087889",
            "telephone_number": "616-656-0100",
            "fax_number": "616-656-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6677 CROSSINGS DRIVE SE",
            "address_2": "SUITE #3",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49508",
            "telephone_number": "616-656-0100",
            "fax_number": "616-656-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISIN",
        "first_name": "KATHLEEN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S, M.S.,PLLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "2901018765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Eischens
• Emiley Jo Eisen, LLMSW
• Richard Bruce Eisen, LMSW
• Lauren Elizabeth Eisenbarth, LMSW
• Bernard Henry Eisenga, M.D.
• Jessica H Eisma, MD
• Ejde Consulting
• Laura Chiamaka Ekeagwu
• Tiana Ekhande, D.O
• Aaron Ronald Ekins

• Periodontics in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.