Jenna Putman

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901021389 Issued in MI

Practice address

610 N Pine River St
Ithaca, MI 48847

Phone

(989) 875-2888

NPI assigned

Oct 1, 2012

Last updated

Dec 10, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Nov 13, 2015 through Nov 13, 2027

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pine River Dental Care

  • General Practice Dentistry
  • Ithaca, MI
  • NPI 1295986479
  NPD (past)
• Putman Dental PLLC

  dba Pine River Dental Care

  • General Practice Dentistry
  • Ithaca, MI
  • NPI 1174925069
  NPD (past)

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449705600000",
    "number": "1841541844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "48847",
            "telephone_number": "989-875-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "48847",
            "telephone_number": "989-875-2888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTMAN",
        "first_name": "JENNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2015-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.023844",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901021389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Persyn
• Pine River Dental Care
• Donald Graham Prouty, M.D.
• Putman Dental PLLC (Pine River Dental Care)
• Brian Joseph Putman, D.D.S.
• Rite Aid of Michigan Inc (Rite Aid Pharmacy 01772)
• Rosewood I & Rosewood II
• Gary Allen Schluckebier, DDS
• Hillary Agnes Shemes, D.O.
• Megan Rose Silvers

• General Practice Dentistry in Ithaca, MI
• Providers in Ithaca, 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 Dec 10, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.