Professional Dental Associates PC

Key facts

NPI: 1992863401
Entity type: Organization (NPI type 2)
Primary specialty: General Practice Dentistry 1223G0001X
License: 2901016945 (MI)
Legal business name: PROFESSIONAL DENTAL ASSOCIATES PC
Practice address: 415 South State Street
Big Rapids, MI 49307-2049
Phone: (231) 796-3571
Fax: (231) 796-2211
NPI assigned: Dec 5, 2006
Organization subpart: No

Authorized official

Name: Dr. Kevin Todd Mathewson, DDS NPI 1912072919
Title: Dentist Owner
Phone: (231) 796-3571

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

Professional Dental Associates PC General Practice Dentistry · Baldwin, MI · NPI 1154592285

NPD tax ID
Professional Dental Associates PC General Practice Dentistry · Barryton, MI · NPI 1750550109

NPD tax ID

Practitioners 6

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

Kevin Todd Mathewson, DDS General Practice Dentistry · Big Rapids, MI · NPI 1912072919

NPD (past) Authorized official GENERAL PRACTICE
Edwin Walter Anderson Jr., DDS General Practice Dentistry · Big Rapids, MI · NPI 1538237052

NPD (past) GENERAL PRACTICE
Donald H French, DDS Dentist · Baldwin, MI · NPI 1689609992

NPD (past)
Benjamin Jarvis Seymour, DDS General Practice Dentistry · Cadillac, MI · NPI 1003981002

NPD (past) GENERAL PRACTICE
Jennifer Ann White, DDS General Practice Dentistry · Manton, MI · NPI 1164590691

NPD (past) GENERAL PRACTICE
Adam Andrew Kuipers, D.D.S. General Practice Dentistry · Eglin Afb, FL · NPI 1699870311

NPD (past) GENERAL PRACTICE

National Provider Directory

Tax ID family: Professional Denatl Asso PC (3 organizations share this tax ID)

Locations

415 S State St
Big Rapids, MI 49307
Phone (231) 296-3571

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	1223G0001X	2901019404	MI
General Practice Dentistry Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	1223G0001X	2901010102	MI
General Practice Dentistry Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	1223G0001X	2901016945	MI	Yes
General Practice Dentistry Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP	1223G0001X	2901019403	MI

Addresses

Primary practice location

415 South State Street
Big Rapids, MI 49307-2049

Mailing address

415 South State Street
Big Rapids, MI 49307-2049
Phone (231) 796-3571

Other identifiers

Identifier	Type	State	Issuer
D8012370	Other	MI	BCBS
1883236	Other	MI	UNITED CONCORDIA
D802980	Other	MI	BCBS
D8012380	Other	MI	BCBS

Other names

Jensen Shroyer Anderson PC Former legal business name

Other providers in Big Rapids, MI

All providers in Big Rapids, MI · General Practice Dentistry in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.