Grand Ledge Family Dentistry, PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

GRAND LEDGE FAMILY DENTISTRY, PLLC

Practice address

416 E River St
Grand Ledge, MI 48837-1764

Phone

(517) 627-9081

NPI assigned

Dec 11, 2020

Organization subpart

No

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

Authorized official

Name

Kyle Mulder, DDSNPI 1881201564

Title

Owner

Phone

(517) 881-0561

Specialties & licenses 1

Addresses

Other names 1

• Kyle A. Mulder, DDS Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Kyle Anthony Mulder, DDS

  • Dentist
  • Grand Ledge, MI
  • NPI 1881201564
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1972199156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 E RIVER ST",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488371764",
            "telephone_number": "517-627-9081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E RIVER ST",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488371764",
            "telephone_number": "517-627-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LEDGE FAMILY DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "MULDER",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-881-0561",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kyle A. Mulder, DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abby Gilbert
• Ayverie Lucille Giller
• Dan Yaw Gordon, PHARMACIST
• Grand Ledge Area Emergency Services
• Grand Ledge Dental Center
• Lauren Victoria Greene, M.D
• Katherine McGarvey Gute, MSW, LCSW, ACSW
• Julie Ann Haan, OTR/L, CLT
• Nolan Hagen, FNP-C
• Kristin L Hamilton, LPC

• All providers in Grand Ledge, MI
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.