Kyle Anthony Mulder, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901600526 Issued in MI

Practice address

416 E River St
Grand Ledge, MI 48837-1764

Phone

(517) 627-9081

NPI assigned

Sep 28, 2020

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

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

Locations

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.

• Grand Ledge Family Dentistry, PLLC

  dba Kyle A. Mulder, DDS

  • Dentist
  • Grand Ledge, MI
  • NPI 1972199156
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1881201564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 S BRIDGE ST",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488371503",
            "telephone_number": "517-881-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E RIVER ST",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488371764",
            "telephone_number": "517-627-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULDER",
        "first_name": "KYLE",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901600526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Minds Over Matter, LLC
• Alicia Montoya, MA, LLP
• Travis Moquin, PHARM.D.
• Patrick Morris, PHARM D
• Allison Morrison, PT, DPT
• Cynthia Denise Munro, NP
• Quan D Nguyen, MD
• Nancy Novakoski, OTR
• Orthodontic Specialists of Mid-Michigan, PC
• Ouderkirk Dental PLLC

• Dentist in Grand Ledge, MI
• Providers in Grand Ledge, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; 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.