Tyler Andrew Wolf, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901017916 Issued in MI

Practice address

7678 Cottonwood Dr
Jenison, MI 49428

Phone

(616) 457-4600

Fax

(616) 457-6021

NPI assigned

Nov 2, 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

Other identifiers 1

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

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.

• Georgetown Family & Cosmetic Dentistry PLC

  • General Practice Dentistry
  • Jenison, MI
  • NPI 1255404992
  NPD Authorized official

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831277136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7678 COTTONWOOD DR",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "49428",
            "telephone_number": "616-457-4600",
            "fax_number": "616-457-6021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7678 COTTONWOOD DR",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "49428",
            "telephone_number": "616-457-4600",
            "fax_number": "616-457-6021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLF",
        "first_name": "TYLER",
        "middle_name": "ANDREW",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901017916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1367809",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Wiersma, DC
• Ryan Anthony Wiersma, FNP-C
• Judy Stearns Williams, L.P.C.
• Julia Williams
• Kayli Williams
• Brian Jacob Wolters, D.C.
• Keith M Wright II, PHARMD
• Michelle A Young
• Marie Lynn Yowtz, LMSW
• Jennifer Lee Zackrison, MSPT

• All providers in Jenison, MI
• Dentist 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.
• 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.