Active NPI
Brian A Mulder, D.D.S.
- Dentist
- Grand Rapids, MI
National Provider Identifier
1700930161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5315022676
- Practice address
- 2008 Eastcastle SE
Suite C
Grand Rapids, MI 49508 - Phone
- (616) 455-8400
- Fax
- (616) 455-4283
- NPI assigned
- Jan 23, 2007
- Last updated
- May 22, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5315022676 | MI | Primary |
Addresses
Primary practice location
2008 Eastcastle SE
Suite C
Grand Rapids, MI 49508
Mailing address
2008 Eastcastle Dr SE Ste C
Grand Rapids, MI 49508-8874
Phone (616) 455-8400
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 |
|---|---|---|---|
| 5315022676 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vanderlugt Dental | Dentist | 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.
-
- Dentist
- Grand Rapids, MI
- NPI 1720275167
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1590105600000",
"number": "1700930161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2008 EASTCASTLE DR SE STE C",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495088874",
"telephone_number": "616-455-8400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2008 EASTCASTLE SE",
"address_2": "SUITE C",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49508",
"telephone_number": "616-455-8400",
"fax_number": "616-455-4283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULDER",
"first_name": "BRIAN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2020-05-22",
"certification_date": "2020-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "5315022676",
"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 May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.