NPIMap

Organization Active NPI

West Michigan Pediatric Dentistry

  • Pediatric Dentistry
  • Holland, MI
National Provider Identifier
1942327259
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
2901012323 Issued in MI
Legal business name
WEST MICHIGAN PEDIATRIC DENTISTRY
Practice address
845 E. 16TH St
Holland, MI 49423
Phone
(616) 392-2381
Fax
(616) 392-3748
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Authorized official

Name
Kathy Wissink
Title
Office Manager
Phone
(616) 392-2381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 2901012323 MI Primary

Addresses

Primary practice location

845 E. 16TH St
Holland, MI 49423

Mailing address

845 E. 16TH St
Holland, MI 49423
Phone (616) 392-2381

Other identifiers 2

IdentifierTypeStateIssuer
4383590-12MedicaidMI
4383607-12MedicaidMI

Other names 1

  • West Michigan Pedatric Dentistry, LLC Other name

National Provider Directory

National Provider Directory

Locations

845 E 16th St
Holland, MI 49423
Phone (616) 392-2381

Practitioners & affiliated clinicians

Practitioners 4

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": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1942327259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 E. 16TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "49423",
            "telephone_number": "616-392-2381",
            "fax_number": "616-392-3748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 E. 16TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "49423",
            "telephone_number": "616-392-2381",
            "fax_number": "616-392-3748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST MICHIGAN PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A",
        "authorized_official_last_name": "WISSINK",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "616-392-2381"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901012323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4383590-12",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4383607-12",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Michigan Pedatric Dentistry, LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "West Michigan Pedatric Dentistry, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Sep 24, 2021; 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.