Active NPI
Brett Kingma, D.D.S.
- Pediatric Dentistry
- Grand Rapids, MI
National Provider Identifier
1669864732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2901021450
- Practice address
- 1179 E Paris Ave SE
Grand Rapids, MI 49546-8371 - Phone
- (616) 942-9840
- Fax
- (616) 942-0170
- NPI assigned
- Feb 26, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2901021450 | MI | Primary |
Addresses
Primary practice location
1179 E Paris Ave SE
Grand Rapids, MI 49546-8371
Mailing address
1392 Clermont St
Denver, CO 80220-2440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901021450 | MI | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424908800000",
"number": "1669864732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1392 CLERMONT ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802202440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1179 E PARIS AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468371",
"telephone_number": "616-942-9840",
"fax_number": "616-942-0170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINGMA",
"first_name": "BRETT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-02-26",
"last_updated": "2015-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MI",
"license": "2901021450",
"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 Feb 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.