Ryan Todd Brunworth, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901019078 Issued in MI

Practice address

504 E Colby St
Whitehall, MI 49461-1165

Phone

(231) 894-8814

Fax

(231) 893-6505

NPI assigned

Aug 30, 2006

Last updated

Apr 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kentwood Family Dental Care, PLC

  • Dental Clinic/Center
  • Kentwood, MI
  • NPI 1346855665
  NPD
• Lakeshore Family Dental Care

  • Dental Clinic/Center
  • Whitehall, MI
  • NPI 1013571322
  NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1699885269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 E COLBY ST",
            "city": "WHITEHALL",
            "state": "MI",
            "postal_code": "494611165",
            "telephone_number": "231-894-8814",
            "fax_number": "231-893-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 E COLBY ST",
            "city": "WHITEHALL",
            "state": "MI",
            "postal_code": "494611165",
            "telephone_number": "231-894-8814",
            "fax_number": "231-893-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNWORTH",
        "first_name": "RYAN",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "19078",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna J. Bailey PLLC
• Deidre Ann Briegel, RPH
• Eric James Briggs, PHARM D
• Melissa Jo Briggs
• Randy D Brown, DC
• Bush Creek Manor
• Carmen Danielle Carlson, LPTA/DOR
• Michael Alan Cihak
• Compass Pointe Medical PLLC
• Comprehensive Professional Services, Inc.

• General Practice Dentistry in Whitehall, MI
• Providers in Whitehall, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.