Jacqueline J Anderson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901015310 Issued in MI

Practice address

1121 Ottawa Beach Road
Suite 100
Holland, MI 49424-2567

Phone

(616) 399-9520

Fax

(616) 399-0945

NPI assigned

Nov 29, 2007

Sex

Female

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196294400000",
    "number": "1992987119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 OTTAWA BEACH ROAD",
            "address_2": "SUITE 100",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242567",
            "telephone_number": "616-399-9520",
            "fax_number": "616-399-0945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 OTTAWA BEACH ROAD",
            "address_2": "SUITE 100",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242567",
            "telephone_number": "616-399-9520",
            "fax_number": "616-399-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACQUELINE",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-29",
        "last_updated": "2007-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901015310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anderson Family and Cosmetic Dentistry
• Ahyana Jade Anderson
• Christopher David Anderson
• Connie M Anderson, PA-C
• Ellen Anderson
• Jami Temple Anderson, PT, DPT, AT, A.T.,C.
• Jeffrey Thomas Anderson
• Linda R Anderson, MS PT
• Matthew Anderson, RPH
• Molly Hunter Anderson

• Dentist in Holland, MI
• Providers in Holland, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.