NPIMap

Organization Active NPI

Grandville Dental Health Center PC

  • Dentist
  • Wyoming, MI
National Provider Identifier
1881843878
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901019378 Issued in MI
Legal business name
GRANDVILLE DENTAL HEALTH CENTER PC
Practice address
4050 Del Mar Dr SW
Suite B
Wyoming, MI 49418-8870
Phone
(616) 531-0360
Fax
(616) 531-2810
NPI assigned
Sep 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

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

Authorized official

Name
Larissa Kyle Bishop, D.D.S.
Title
President
Phone
(616) 531-0360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2901019378 MI Primary

Addresses

Primary practice location

4050 Del Mar Dr SW
Suite B
Wyoming, MI 49418-8870

Mailing address

4050 Del Mar Dr SW
Suite B
Wyoming, MI 49418-8870
Phone (616) 531-0360

Other identifiers 1

IdentifierTypeStateIssuer
4487030MedicaidMI

National Provider Directory

National Provider Directory

Locations

4050 Del Mar Dr SW
Ste B
Wyoming, MI 49418
Phone (616) 531-0360

NPI Registry JSON

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1881843878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 DEL MAR DR SW",
            "address_2": "SUITE B",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "494188870",
            "telephone_number": "616-531-0360",
            "fax_number": "616-531-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 DEL MAR DR SW",
            "address_2": "SUITE B",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "494188870",
            "telephone_number": "616-531-0360",
            "fax_number": "616-531-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDVILLE DENTAL HEALTH CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-15",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "LARISSA",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-531-0360",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4487030",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.