Larry Wildt, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11365 Issued in MI

Practice address

2515 Alpine Ave NW
Suite a
Grand Rapids, MI 49544-1924

Phone

(616) 364-9348

Fax

(616) 364-5950

NPI assigned

Sep 28, 2006

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

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.

• Kent Family Dental Care

  • General Practice Dentistry
  • Grand Rapids, MI
  • NPI 1538250907
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780775130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1344 WINTERWOOD DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495253441",
            "telephone_number": "616-364-9348",
            "fax_number": "616-364-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 ALPINE AVE NW",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495441924",
            "telephone_number": "616-364-9348",
            "fax_number": "616-364-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDT",
        "first_name": "LARRY",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "11365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Burke Wildey, PA
• Wildflower Wellness Therapy LLC
• Abrielle Marie Wildman, DNP, RN, AGNP-C
• Kayla Wildman
• Danielle E Wildrick, MD
• Jeniffer Wiley
• Sandra Verlay Wilfore, FNP-C
• Kirsten Rosemarie Wilhelm, MD
• Maju Basila Wilhelm, RN
• Norman R Wilhelmsen, D.D.S.,M.S.

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.