Individual provider Active NPI

Robert Scott Dame, DDS

  • General Practice Dentistry
  • Grand Rapids, MI
National Provider Identifier
1689610826
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901016066 Issued in MI
Practice address
422 N Park St NE
Grand Rapids, MI 49525-2580
Phone
(616) 361-7265
Fax
(616) 361-9410
NPI assigned
Jun 22, 2006
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 2901016066 MI Primary

Addresses

Primary practice location

422 N Park St NE
Grand Rapids, MI 49525-2580

Mailing address

612 Old School Forest LN
Sparta, MI 49345-9594
Phone (616) 887-8114

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
I20170105001279 MI Order and Referring Only - DentistPractitioner - Dentist 3577844547

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
North Park Family Dental PLLC 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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689610826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 OLD SCHOOL FOREST LN",
            "city": "SPARTA",
            "state": "MI",
            "postal_code": "493459594",
            "telephone_number": "616-887-8114",
            "fax_number": "616-361-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 N PARK ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495252580",
            "telephone_number": "616-361-7265",
            "fax_number": "616-361-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAME",
        "first_name": "ROBERT",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901016066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.