Individual provider Active NPI

Alicia Ranae Nieuwkoop, DDS

  • Dentist
  • Grandville, MI
National Provider Identifier
1407349012
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901022628 Issued in MI
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

Updated by the provider on Jun 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901022628MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Upper Great Lakes Family Health Center CurrentSince Jul 1, 2018 Accepting new patients
Upper Great Lakes Family Health Center Current Accepting new patients
Upper Great Lakes Family Health Center CurrentSince Jul 1, 2018 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.

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

Verify at the official NPI Registry.