NPIMap

Organization Active NPI

Spring Lake Family Dentistry

  • Dental Clinic/Center
  • Spring Lake, MI
National Provider Identifier
1396136271
Registry record updated Feb 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
E1557U Issued in MI
Legal business name
SPRING LAKE FAMILY DENTISTRY
Practice address
102 S Buchanan St
Ste a
Spring Lake, MI 49456-2090
Phone
(616) 846-5690
Fax
(616) 846-6160
NPI assigned
Feb 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2015

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

Authorized official

Name
Jared M Vanittersum, DDS
Title
Owner/Dentist
Phone
(616) 846-5690

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X E1557U MI Primary

Addresses

Primary practice location

102 S Buchanan St
Ste a
Spring Lake, MI 49456-2090

Mailing address

102 S Buchanan St
Ste a
Spring Lake, MI 49456-2090
Phone (616) 846-5690

National Provider Directory

National Provider Directory

Locations

102 S Buchanan St
Ste A
Spring Lake, MI 49456
Phone (616) 846-5690

NPI Registry JSON

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

{
    "created_epoch": "1423699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1396136271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S BUCHANAN ST",
            "address_2": "STE A",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494562090",
            "telephone_number": "616-846-5690",
            "fax_number": "616-846-6160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S BUCHANAN ST",
            "address_2": "STE A",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494562090",
            "telephone_number": "616-846-5690",
            "fax_number": "616-846-6160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING LAKE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-12",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "VANITTERSUM",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "616-846-5690",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": "E1557U",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; 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.