Stuart Pettijohn, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901020216 Issued in MI

Practice address

4500 Cascade Rd SE Ste 100
Grand Rapids, MI 49546-3665

Phone

(616) 942-8301

NPI assigned

Jun 9, 2010

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Stuart Pettijohn DDS PLLC

  • Dentist
  • Grand Rapids, MI
  • NPI 1295254035
  NPD Authorized official

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

{
    "created_epoch": "1276041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1710207097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 CASCADE RD SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463665",
            "telephone_number": "616-942-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 CASCADE RD SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463665",
            "telephone_number": "616-942-8301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "128 S Broad St",
            "address_purpose": "LOCATION",
            "city": "Adrian",
            "state": "MI",
            "postal_code": "492212723",
            "country_code": "US",
            "telephone_number": "517-266-0651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTIJOHN",
        "first_name": "STUART",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Alvin Petrovich, MSW
• Breanna Marie Petrucciani, MS, RDN
• Lauren Petruska
• Susanne Pettigrew, PA-C
• Erin Megan Pettijohn, M.D.
• Jayne Deur Pettinga, NURSE PRACTITIONER
• Matthew Scott Pettinga, MA, LPC
• Taylor Pettit-Rademaker, LMSW, CAADC
• Kayla Lynne Pettit
• Lindsey Pettit, PA-C

• Dentist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.