Individual provider Active NPI

Jonathan Griffin, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Rapids, MI
National Provider Identifier
1780204693
Registry record updated Jul 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2901602913 Issued in MI
Practice address
2000 43Rd St SE Ste D
Grand Rapids, MI 49508-8700
Phone
(616) 735-2870
Fax
(616) 735-2871
NPI assigned
Apr 21, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 2901602913 MI Primary

Addresses

Primary practice location

2000 43Rd St SE Ste D
Grand Rapids, MI 49508-8700

Mailing address

2140 Lake Michigan Dr NW
Grand Rapids, MI 49504-4785
Phone (616) 735-2870

Other practice location 1

1299 M 89 Ste 2
Plainwell, MI 49080-1934
Phone (616) 735-2871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200812001545 KY Order and Referring Only - Maxillofacial SurgeryPractitioner - Maxillofacial Surgery 0941626659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
10456KYMDDentist
2901602913MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Oral & Maxillofacial Surgery Associates of Western Michigan PLC Oral and Maxillofacial Surgery 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784332800000",
    "number": "1780204693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 LAKE MICHIGAN DR NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044785",
            "telephone_number": "616-735-2870",
            "fax_number": "616-735-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 43RD ST SE STE D",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495088700",
            "telephone_number": "616-735-2870",
            "fax_number": "616-735-2871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1299 M 89 Ste 2",
            "address_purpose": "LOCATION",
            "city": "Plainwell",
            "state": "MI",
            "postal_code": "490801934",
            "country_code": "US",
            "telephone_number": "616-735-2871",
            "fax_number": "616-735-2871",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIFFIN",
        "first_name": "JONATHAN",
        "credential": "DMD, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-21",
        "last_updated": "2026-07-18",
        "certification_date": "2026-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901602913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.