Michigan Center for TMJ Sleep Disorders

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MICHIGAN CENTER FOR TMJ SLEEP DISORDERS

Practice address

515 Michigan St NE
Ste 202
Grand Rapids, MI 49503

Phone

(616) 458-0631

NPI assigned

Jun 8, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Jerry B Mulder Jr., DDS

Title

Owner

Phone

(616) 458-0631

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1992234264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 MICHIGAN ST NE STE 202",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035721",
            "telephone_number": "616-458-0631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MICHIGAN ST NE",
            "address_2": "STE 202",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-458-0631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN CENTER FOR TMJ SLEEP DISORDERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MULDER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-458-0631",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 21, 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.