Active NPI
Alicia Ranae Nieuwkoop, DDS
- Dentist
- Grandville, MI
National Provider Identifier
1407349012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901022628
- Practice address
- 3100 Ivanrest Ave SW Ste 105
Grandville, MI 49418-2955 - Phone
- (616) 538-3060
- NPI assigned
- Jun 8, 2018
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2901022628 | MI | Primary |
Addresses
Primary practice location
3100 Ivanrest Ave SW Ste 105
Grandville, MI 49418-2955
Mailing address
3100 Ivanrest Ave SW Ste 105
Grandville, MI 49418-2955
Phone (616) 538-3060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901022628 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upper Great Lakes Family Health Center | Current | Accepting new patients | |
| Upper Great Lakes Family Health Center | Current | Accepting new patients | |
| Upper Great Lakes Family Health Center | Current | Accepting new patients | |
| Ivanrest Family Dentistry | Dentist | Past | Accepting new patients |
Locations
301 Explorer St
Gwinn, MI 49841
Phone (906) 346-4924
135 E State Highway M35
Gwinn, MI 49841
Phone (906) 346-9275
506 Campus Dr
Hancock, MI 49930
Phone (906) 483-1000
56720 Calumet Ave
Laurium, MI 49913
Phone (906) 481-8952
Organizations & group practices 4
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.
-
- Federally Qualified Health Center (FQHC)
- Laurium, MI
- NPI 1114788619
-
- Federally Qualified Health Center (FQHC)
- Gwinn, MI
- NPI 1164893491
-
- Federally Qualified Health Center (FQHC)
- Gwinn, MI
- NPI 1700103777
-
- Dentist
- Grandville, MI
- NPI 1215483284
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782432000000",
"number": "1407349012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 IVANREST AVE SW STE 105",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494182955",
"telephone_number": "616-538-3060",
"fax_number": "906-346-6474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 IVANREST AVE SW STE 105",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494182955",
"telephone_number": "616-538-3060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEUWKOOP",
"first_name": "ALICIA",
"middle_name": "RANAE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-08",
"last_updated": "2026-06-26",
"certification_date": "2026-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901022628",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Grandville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.