NPIMap

Organization Active NPI

Glen Valley Dentistry

  • General Practice Dentistry
  • Caledonia, MI
National Provider Identifier
1538100482
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901014542 Issued in MI
Legal business name
GLEN VALLEY DENTISTRY
Practice address
9041 N Rodgers CT SE
Caledonia, MI 49316-7660
Phone
(616) 891-8931
Fax
(616) 891-9803
NPI assigned
Jun 10, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mrs. Robin T. Vaughan, DDSNPI 1689681322
Title
Owner/Dentist
Phone
(616) 891-8931

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2901014542 MI Primary

Addresses

Primary practice location

9041 N Rodgers CT SE
Caledonia, MI 49316-7660

Mailing address

9041 N Rodgers CT SE
Caledonia, MI 49316-7660
Phone (616) 891-8931

Other identifiers 3

IdentifierTypeStateIssuer
D801041OtherMIBCBS OF MI
846910OtherMIUNITED CONCORDIA #
4836800MedicaidMI

National Provider Directory

National Provider Directory

Locations

9041 N Rodgers Ct SE
Caledonia, MI 49316
Phone (616) 891-8931

Practitioners & affiliated clinicians

Practitioners 3

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": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1538100482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9041 N RODGERS CT SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493167660",
            "telephone_number": "616-891-8931",
            "fax_number": "616-891-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9041 N RODGERS CT SE",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493167660",
            "telephone_number": "616-891-8931",
            "fax_number": "616-891-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN VALLEY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "616-891-8931",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "D801041",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA #",
            "identifier": "846910",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4836800",
            "state": "MI"
        }
    ],
    "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 20, 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.