Individual provider Active NPI

Timothy P. Vanitvelt, DDS

  • General Practice Dentistry
  • Flint, MI
National Provider Identifier
1669509766
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17209 Issued in MI
Practice address
4500 Town Center Pkwy
Flint, MI 48532-3435
Phone
(810) 733-1410
Fax
(810) 733-6535
NPI assigned
Feb 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 17209 MI Primary

Addresses

Primary practice location

4500 Town Center Pkwy
Flint, MI 48532-3435

Mailing address

4500 Town Center Pkwy
Flint, MI 48532-3435
Phone (810) 733-1410

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
I20161102001511 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1254619836

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17209MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Town Center Family Dental 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669509766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 TOWN CENTER PKWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323435",
            "telephone_number": "810-733-1410",
            "fax_number": "810-733-6535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 TOWN CENTER PKWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323435",
            "telephone_number": "810-733-1410",
            "fax_number": "810-733-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANITVELT",
        "first_name": "TIMOTHY",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "17209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.