John Vander Kolk, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901014158 Issued in MI

Practice address

15 Andre St SE
Grand Rapids, MI 49507-3010

Phone

(616) 475-8446

Fax

(616) 475-1272

NPI assigned

Jul 20, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8589/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Exalta Health

  • Specialist
  • Grand Rapids, MI
  • NPI 1588840854
  NPD (past)

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

{
    "created_epoch": "1311120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311120000000",
    "number": "1992093298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 ANDRE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495073010",
            "telephone_number": "616-475-8446",
            "fax_number": "616-475-1272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 ANDRE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495073010",
            "telephone_number": "616-475-8446",
            "fax_number": "616-475-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER KOLK",
        "first_name": "JOHN",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-20",
        "last_updated": "2011-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Vander Bos
• Susan Kim Vander Griend
• Lysandra Vander Hart, R.D.
• Donna Kay Vander Kodde, MA, LPC
• Jacob Scott Vander Kolk, LLPC
• Karen S Vander Laan, MD
• Vander Linde Family and Cosmetic Dentistry
• Donald John Vander Linde Jr., DDS
• Joel Thomas Vander Lugt, M. D.
• Craig Robert Vander Maas, PSYD

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2011; 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.