NPIMap

Organization Active NPI

Peters Family Dentistry, PLLC

  • General Practice Dentistry
  • Grand Rapids, MI
National Provider Identifier
1417491119
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
16299 Issued in MI
Legal business name
PETERS FAMILY DENTISTRY, PLLC
Practice address
6651 Crossings Dr SE
Ste a
Grand Rapids, MI 49508-7894
Phone
(616) 698-6663
NPI assigned
Dec 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Authorized official

Name
Debra Peters
Title
Owner
Phone
(616) 698-6663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 16299 MI Primary

Addresses

Primary practice location

6651 Crossings Dr SE
Ste a
Grand Rapids, MI 49508-7894

Mailing address

6651 Crossings Dr SE
Ste a
Grand Rapids, MI 49508-7894

National Provider Directory

National Provider Directory

Locations

6651 Crossings Dr SE
Ste A
Grand Rapids, MI 49508
Phone (616) 698-6663

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1417491119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6651 CROSSINGS DR SE",
            "address_2": "STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6651 CROSSINGS DR SE",
            "address_2": "STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087894",
            "telephone_number": "616-698-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERS FAMILY DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-14",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-698-6663"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "16299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; 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.