Pediatric Dentistry and Orthodontics of Jackson

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTISTRY AND ORTHODONTICS OF JACKSON

Practice address

900 E Michigan Ave Ste 100
Jackson, MI 49201-2457

Phone

(517) 376-3142

NPI assigned

Mar 7, 2022

Last updated

Mar 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ly Julie Van, DDSNPI 1134572472

Title

Pediatric Dentist

Phone

(586) 744-9869

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ly Julie Van, D.D.S.

  • Dentist
  • Ann Arbor, MI
  • NPI 1134572472
  NPD Authorized official

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

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1952058133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 E MICHIGAN AVE STE 100",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012457",
            "telephone_number": "517-376-3142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 E MICHIGAN AVE STE 100",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012457",
            "telephone_number": "517-376-3142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY AND ORTHODONTICS OF JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-07",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A",
        "authorized_official_last_name": "VAN",
        "authorized_official_first_name": "LY",
        "authorized_official_middle_name": "JULIE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "586-744-9869",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylie Payne
• Salina Payne
• Pdhcrc, Inc. (Potential Development Homes, Inc.)
• Pearle Vision Inc (Pearle Vision #C6837)
• Pediatric Center of Jackson
• Brent Peek
• Dirk Peeters, PA-C
• Randoplh Penn, D.C.
• Shannon Penn, PHARMD
• Manny Isiah Pennell

• Pediatric Dentistry in Jackson, MI
• Providers in Jackson, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; 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.