Grand River Endodontics PC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

2901019457 Issued in MI

Legal business name

GRAND RIVER ENDODONTICS PC

Practice address

4211 Parkway Place Dr SW
Suite 104
Grandville, MI 49418-2695

Phone

(616) 249-3500

Fax

(616) 249-3502

NPI assigned

Oct 7, 2014

Reactivated

Sep 30, 2017

Last updated

Sep 30, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sarah Lennan Masterson, DDS, MSDNPI 1467636506

Title

Owner/Endodontist

Phone

(616) 249-3500

Specialties & licenses 1

Addresses

Locations

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.

• Sarah Lennan Masterson, DDS, MSD

  • Endodontics
  • Grandville, MI
  • NPI 1467636506
  NPD (past) Authorized official

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506729600000",
    "number": "1518360304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 PARKWAY PLACE DR SW",
            "address_2": "SUITE 104",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182695",
            "telephone_number": "616-249-3500",
            "fax_number": "616-249-3502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 PARKWAY PLACE DR SW",
            "address_2": "SUITE 104",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182695",
            "telephone_number": "616-249-3500",
            "fax_number": "616-249-3502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RIVER ENDODONTICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-07",
        "last_updated": "2017-09-30",
        "deactivation_date": "2014-10-21",
        "reactivation_date": "2017-09-30",
        "status": "A",
        "authorized_official_last_name": "MASTERSON",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "LENNAN",
        "authorized_official_title_or_position": "OWNER/ENDODONTIST",
        "authorized_official_telephone_number": "616-249-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MI",
            "license": "2901019457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Endodontics in Grandville, MI
• Providers in Grandville, MI by specialty
• Endodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2017; 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.