NPIMap

Organization Active NPI

Mitten Kids Dentistry Caledonia PLC

  • Pediatric Dentistry
  • Caledonia, MI
National Provider Identifier
1457914038
Registry record updated Apr 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
MITTEN KIDS DENTISTRY CALEDONIA PLC
Practice address
6477 Cherry Meadow Dr SE Ste 4
Caledonia, MI 49316-7351
Phone
(616) 942-9840
NPI assigned
Apr 18, 2019
Last updated
Apr 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2019

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

Authorized official

Name
Grady Randall, DDSNPI 1609188531
Title
Owner
Phone
(616) 942-9840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X Primary

Addresses

Primary practice location

6477 Cherry Meadow Dr SE Ste 4
Caledonia, MI 49316-7351

Mailing address

1179 E Paris Ave SE Ste 130
Grand Rapids, MI 49546-3682
Phone (616) 552-9701

National Provider Directory

National Provider Directory

Locations

6477 Cherry Meadow Dr SE
Ste 4
Caledonia, MI 49316
Phone (616) 942-9840

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555545600000",
    "number": "1457914038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 E PARIS AVE SE STE 130",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463682",
            "telephone_number": "616-552-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6477 CHERRY MEADOW DR SE STE 4",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493167351",
            "telephone_number": "616-942-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITTEN KIDS DENTISTRY CALEDONIA PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-04-18",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "GRADY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-942-9840",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caledonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; 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.