James Mark Domin, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901016850 Issued in MI

Practice address

2140 Lake Michigan Dr NW
Grand Rapids, MI 49504-4785

Phone

(616) 735-2870

Fax

(616) 735-2871

NPI assigned

Oct 4, 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 2

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Oral & Maxillofacial Surgery Associates of Western Michigan PLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Grand Rapids, MI
  • NPI 1598772626

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1891880654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 PARCHMENT DR SE",
            "address_2": "SUITE 125",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462303",
            "telephone_number": "616-735-2870",
            "fax_number": "616-735-2871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 LAKE MICHIGAN DR NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044785",
            "telephone_number": "616-735-2870",
            "fax_number": "616-735-2871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMIN",
        "first_name": "JAMES",
        "middle_name": "MARK",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901016850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0D111530",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSD",
            "identifier": "168500",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian M Dolphin, OD
• Anitha Reddy Doma, BDS
• James Domagala, LMSW
• Melanie Dombrowski, PT, DPT
• Leahthan Faye Domeshek, MD
• Reyna Cassidy Dominczak
• David Arturo Dominguez, PA-C
• Mariah Paz Dominguez, PA-C
• Melanie Dominguez, PA-C
• Debra Dominiak-Rinck, LMSW

• Oral and Maxillofacial Surgery (Dentist) in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.