Individual provider Active NPI

Heather Vannuil Holton, D.D.S

  • General Practice Dentistry
  • Hudsonville, MI
National Provider Identifier
1639607112
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901022232 Issued in MI
Practice address
5813 Balsam Dr
Hudsonville, MI 49426-1104
Phone
(616) 669-2040
NPI assigned
May 30, 2017
Last updated
Sep 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901022232 MI Primary

Addresses

Primary practice location

5813 Balsam Dr
Hudsonville, MI 49426-1104

Mailing address

4770 N 160TH Ave
Holland, MI 49424-5577
Phone (616) 405-7003

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170620003340 MI Order and Referring Only - DentistPractitioner - Dentist 3678841491

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901022232MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Hudsonvile Family Dentistry General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1639607112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 N 160TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494245577",
            "telephone_number": "616-405-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5813 BALSAM DR",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494261104",
            "telephone_number": "616-669-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTON",
        "first_name": "HEATHER",
        "middle_name": "VANNUIL",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-30",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901022232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hudsonville, MI

Sources for this page

Verify at the official NPI Registry.