Pediatric Dentistry of Michigan PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTISTRY OF MICHIGAN PLLC

Practice address

3297 Eagle Run Dr NE
Grand Rapids, MI 49525-7050

Phone

(917) 597-6749

NPI assigned

Aug 30, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Wanki Kim, DDSNPI 1780003749

Title

Owner

Phone

(917) 597-6749

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wanki Kim, DDS

  • Pediatric Dentistry
  • Plattsburgh, NY
  • NPI 1780003749
  NPD Authorized official

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

{
    "created_epoch": "1598745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1831702695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3297 EAGLE RUN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257050",
            "telephone_number": "917-597-6749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3297 EAGLE RUN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257050",
            "telephone_number": "917-597-6749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY OF MICHIGAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-30",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "WANKI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-597-6749",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Peckham
• Ashley Pecott
• Abbigal Louise Pecynski
• Maya Pedersen, PHARMD
• Pediatric Dental Specialists of West Michigan
• Pediatric Ophthalmology PC
• Pediatric Psychologists of West Michigan, PLC
• Pediatric Speech Services LLC
• Pediatric Surgeons of West Michigan PC
• Maureen Tan Pedres, M.D.

• Pediatric Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.