Jared Matthew Vanittersum, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901019772 Issued in MI

Practice address

1221 E Sherman Blvd
Muskegon, MI 49444-1811

Phone

(231) 739-5105

Fax

(231) 739-7432

NPI assigned

Jun 6, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Shoreline Dental Associates, P.C.

  • Dentist
  • Muskegon, MI
  • NPI 1144327412
  NPD (past)
• Shoreline Dental PLLC

  • General Practice Dentistry
  • Norton Shores, MI
  • NPI 1013211093
  NPD (past)

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212710400000",
    "number": "1497914113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441811",
            "telephone_number": "231-739-5105",
            "fax_number": "231-739-7432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441811",
            "telephone_number": "231-739-5105",
            "fax_number": "231-739-7432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANITTERSUM",
        "first_name": "JARED",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-06",
        "last_updated": "2008-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda M Vandyke, PT
• Barbara Ann Vanfossen, LBSW
• Kristen N Vanhouten
• Laverne W Vanhouten, MA
• Troy Vanhouten
• Koryn M Vanittersum, M.D.
• Lori Vanklompenberg, LPN
• John Edward Vanlente, LCSW
• Emilee Vanlinden, LLMSW
• Austin Vanree, PA-C

• Dentist in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; 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.