NPIMap

Organization Active NPI

Dental Design P.C.

  • Dentist
  • Grand Rapids, MI
National Provider Identifier
1891892006
Registry record updated Nov 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901015828 Issued in MI
Legal business name
DENTAL DESIGN P.C.
Practice address
2021 44TH St SE Ste B
Grand Rapids, MI 49508-5349
Phone
(616) 452-0400
Fax
(855) 918-1014
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2019

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

Authorized official

Name
Dr. Tracy Elaine Blount, DDSNPI 1326145046
Title
President
Phone
(616) 452-0400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2901015828 MI Primary

Addresses

Primary practice location

2021 44TH St SE Ste B
Grand Rapids, MI 49508-5349

Mailing address

PO Box 88007
Grand Rapids, MI 49518-0007
Phone (616) 452-0400

Other practice location 1

1014 Franklin St SE
Grand Rapids, MI 49507-1327
Phone (616) 452-0400

Other identifiers 1

IdentifierTypeStateIssuer
2759918MedicaidMI

Other names 1

  • Tracy E. Mathis DDS P.C. Former legal business name

National Provider Directory

National Provider Directory

Locations

2021 44th St SE
Ste B
Grand Rapids, MI 49508
Phone (616) 827-8981

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573689600000",
    "number": "1891892006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88007",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495180007",
            "telephone_number": "616-452-0400",
            "fax_number": "855-918-1014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 44TH ST SE STE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495085349",
            "telephone_number": "616-452-0400",
            "fax_number": "855-918-1014"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1014 Franklin St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495071327",
            "country_code": "US",
            "telephone_number": "616-452-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DENTAL DESIGN P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-11-14",
        "status": "A",
        "authorized_official_last_name": "BLOUNT",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-452-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901015828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2759918",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tracy E. Mathis DDS P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Tracy E. Mathis DDS P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; 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.