Douglas A Bleyenburg, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

16773 Issued in MI

Practice address

170 College Ave Ste 220
Holland, MI 49423-2982

Phone

(616) 392-2302

Fax

(616) 392-9070

NPI assigned

Nov 2, 2008

Sex

Male

Sole proprietor

Yes

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Douglas a Bleyenburg DDS PC

  • Dentist
  • Holland, MI
  • NPI 1083624662
  NPD (past) Authorized official

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

{
    "created_epoch": "1225584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225584000000",
    "number": "1811140973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 COLLEGE AVE STE 220",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494232982",
            "telephone_number": "616-392-2302",
            "fax_number": "616-392-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 COLLEGE AVE STE 220",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494232982",
            "telephone_number": "616-392-2302",
            "fax_number": "616-392-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEYENBURG",
        "first_name": "DOUGLAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-02",
        "last_updated": "2008-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "16773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjermen Alan Blackmer, DO
• Thomas Blackport
• Susan Lynn Blaine, LMSW
• Jason Chad Blanks, M.S.
• Kyle Jon Blauwkamp, D.C.
• Joseph R Blodgett, M.D.
• Brittney Bloomquist
• Eleanor Elizabeth Blouw, CRNA
• David Jon Blystra
• Tracy Ann Bobo, LMSW

• Dentist in Holland, MI
• Providers in Holland, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.