Contemporary Family Dental

Primary specialty

DentistTaxonomy code 122300000X

License

11799 Issued in MI

Legal business name

CONTEMPORARY FAMILY DENTAL

Practice address

2005 Breton Rd SE
Grand Rapids, MI 49546

Phone

(616) 926-1271

Fax

(616) 726-1273

NPI assigned

Jun 10, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Bradley A Dykstra, DDS

Title

Owner

Phone

(616) 669-6600

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1962815605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 BRETON RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-726-1271",
            "fax_number": "616-726-1273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 BRETON RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-926-1271",
            "fax_number": "616-726-1273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONTEMPORARY FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "DYKSTRA",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-669-6600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "11799",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "12554",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "18713",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "19719",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; 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.