Port Pediatric Dentistry PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PORT PEDIATRIC DENTISTRY PC

Practice address

291 W Lakewood Blvd
Holland, MI 49424-1969

Phone

(616) 392-1100

Fax

(616) 396-1117

NPI assigned

Jul 16, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Suzanne Kristen Port, DDS,MSNPI 1700925690

Title

Dentist/Owner

Phone

(616) 392-1100

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Suzanne K Port, DDS MS

  • Pediatric Dentistry
  • Holland, MI
  • NPI 1700925690
  NPD Authorized official

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594857600000",
    "number": "1669080651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 W LAKEWOOD BLVD",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494241969",
            "telephone_number": "616-392-1100",
            "fax_number": "616-396-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 W LAKEWOOD BLVD",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494241969",
            "telephone_number": "616-392-1100",
            "fax_number": "616-396-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT PEDIATRIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-16",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A",
        "authorized_official_last_name": "PORT",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "KRISTEN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "616-392-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS,MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smiles@portkidsdds.com",
            "affiliation": "N",
            "address_1": "291 W Lakewood Blvd",
            "city": "Holland",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494241969",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cynthia Helen Pollet, LPC
• Bruce E Pommerening, CMT, CR
• Tara Poore
• Katee Elizabeth Pope, PA
• Madeleine Popp
• Suzanne K Port, DDS MS
• Porto Orthodontics PLLC
• Positive Directions Wellness Center
• Elise Post
• Gregory Scott Post, PA-C

• Pediatric Dentistry in Holland, MI
• Providers in Holland, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; 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.