Active NPI
Jeremey J Thietten, D.D.S.
- Dentist
- Lakeview, MI
National Provider Identifier
1679743082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901019669
- Practice address
- 924 S Lincoln Ave
Lakeview, MI 48850-9174 - Phone
- (989) 352-6477
- Fax
- (989) 352-8348
- NPI assigned
- Mar 3, 2008
- Last updated
- Apr 3, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5315032828 | MI | |
| Dentist | 122300000X | 2901019669 | MI | Primary |
Addresses
Primary practice location
924 S Lincoln Ave
Lakeview, MI 48850-9174
Mailing address
924 S Lincoln Ave
PO Box 530
Lakeview, MI 48850-9174
Phone (989) 352-6477
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 |
|---|---|---|---|
| 2901019669 | MI | MD | Dentist |
| 5315032828 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeview Dental Associates | 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.
-
- General Practice Dentistry
- Lakeview, MI
- NPI 1407006281
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238716800000",
"number": "1679743082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "924 S LINCOLN AVE",
"address_2": "PO BOX 530",
"city": "LAKEVIEW",
"state": "MI",
"postal_code": "488509174",
"telephone_number": "989-352-6477",
"fax_number": "989-352-8348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "924 S LINCOLN AVE",
"city": "LAKEVIEW",
"state": "MI",
"postal_code": "488509174",
"telephone_number": "989-352-6477",
"fax_number": "989-352-8348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIETTEN",
"first_name": "JEREMEY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-03",
"last_updated": "2009-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "5315032828",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901019669",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeview, MI
- Spectrum Health United (Spectrum Health United Hospital)
- Spectrum Health United (Corewell Health Greenville Hospital Multispecialty Center - Lakeview)
- Spectrum Health United
- Spectrum Heatlh Kelsey (Kelsey Memorial Health Center)
- Har Swarup, MD
- Harry Keith Treiber, DDS
- USA Hears LLC
- Melvin Michael Vallette, NURSE PRACTITIONER
- Sarah Rose Vanderhoof, PA-C
- Erin Coleen Vining
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.