Kent R Wildern DDS PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KENT R WILDERN DDS PC

Practice address

4701 Plainfield Ave NE
Grand Rapids, MI 49525-1644

Phone

(616) 364-8716

Fax

(616) 364-8716

NPI assigned

Jul 14, 2017

Organization subpart

Yes

Parent organization

KENT R WILDERN DDS PCAs reported in NPPES

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

Authorized official

Name

Dr. Kent Raymond Wildern, DDS

Title

Owner

Phone

(616) 364-8716

Specialties & licenses 1

Addresses

Part of

Kent R Wildern D D S PC

Locations

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750803300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 PLAINFIELD AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251644",
            "telephone_number": "616-364-8716",
            "fax_number": "616-364-8829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 PLAINFIELD AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251644",
            "telephone_number": "616-364-8716",
            "fax_number": "616-364-8716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT R WILDERN DDS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENT R WILDERN DDS PC",
        "enumeration_date": "2017-07-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILDERN",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-364-8716",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kent Otolaryngology Associates, P.C.
• Kent Pathologists PLLC
• Kent Pathology Laboratory PLLC
• Kent Pathology Laboratory PLLC
• Kent Podiatry
• Kent Radiology PC
• Kent Residential Centers, Inc
• Kent Vision Centers Inc (Smeelink Optical)
• Kent Vision Centers Inc (Kent Optical)
• Kent Vision Centers Inc (Smeelink Optical)

• Dental Clinic/Center in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dental Clinic/Center 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.