Jeffrey Schaefer Smith, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

13205 Issued in MI

Practice address

3050 Ivanrest Ave SW
Suite B
Grandville, MI 49418-1400

Phone

(616) 531-1554

Fax

(616) 531-6947

NPI assigned

Jul 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

Credentials

Master of Science

State licenses

Practice roles

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.

• Grand River Periodontics, PLLC

  • Periodontics
  • Grandville, MI
  • NPI 1326715665
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700818440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 IVANREST AVE SW",
            "address_2": "SUITE B",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181400",
            "telephone_number": "616-531-1554",
            "fax_number": "616-531-6947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 IVANREST AVE SW",
            "address_2": "SUITE B",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181400",
            "telephone_number": "616-531-1554",
            "fax_number": "616-531-6947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JEFFREY",
        "middle_name": "SCHAEFER",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "13205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Sieting
• Andrea Leigh Simon
• Anthony Sleep
• Emily Brooke Sluiter, LMSW
• Jacqueline Ann Smith
• Joshua Smith, DDS
• Kaitlyn Marie Smith
• Katherine Anne Smith, MD
• Kaylee Elizabeth Snyder, BT
• Esther A Sobong, MD

• Periodontics in Grandville, MI
• Providers in Grandville, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.