Active NPI
Jeffrey Thomas Deyoung, D.D.S.
- Oral and Maxillofacial Surgery (Dentist)
- Holland, MI
National Provider Identifier
1932638822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 2901601286
- Practice address
- 601 Michigan Ave Ste 200
Holland, MI 49423-4951 - Phone
- (616) 392-2329
- NPI assigned
- Jun 5, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2901601286 | MI | Primary |
Addresses
Primary practice location
601 Michigan Ave Ste 200
Holland, MI 49423-4951
Mailing address
4590 Wren Dr SE
Caledonia, MI 49316-9288
Phone (616) 560-2015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 2, 2024 through Jul 2, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901601286 | MI | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657152000000",
"number": "1932638822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4590 WREN DR SE",
"city": "CALEDONIA",
"state": "MI",
"postal_code": "493169288",
"telephone_number": "616-560-2015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 MICHIGAN AVE STE 200",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494234951",
"telephone_number": "616-392-2329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEYOUNG",
"first_name": "JEFFREY",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-05",
"last_updated": "2022-07-07",
"certification_date": "2022-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "MI",
"license": "2901601286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.