Active NPI
Fresh Coast Pediatric Dentistry
- Dental Clinic/Center
- Grand Rapids, MI
National Provider Identifier
1629982939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- FRESH COAST PEDIATRIC DENTISTRY
- Practice address
- 933 3 Mile Rd NW Ste 102
Grand Rapids, MI 49544-1673 - Phone
- (616) 606-3811
- NPI assigned
- Oct 1, 2026
- Last updated
- Oct 1, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Taryn Weil, DDS
- Title
- Owner
- Phone
- (616) 606-3811
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | NU | Primary |
Addresses
Primary practice location
933 3 Mile Rd NW Ste 102
Grand Rapids, MI 49544-1673
Mailing address
820 Gladstone Dr SE
Grand Rapids, MI 49506-3334
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790812800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790812800000",
"number": "1629982939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 GLADSTONE DR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495063334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "933 3 MILE RD NW STE 102",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495441673",
"telephone_number": "616-606-3811"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FRESH COAST PEDIATRIC DENTISTRY",
"organizational_subpart": "NO",
"enumeration_date": "2026-10-01",
"last_updated": "2026-10-01",
"certification_date": "2026-10-01",
"status": "A",
"authorized_official_last_name": "WEIL",
"authorized_official_first_name": "TARYN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "616-606-3811",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "NU",
"license": null,
"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 Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.