MODERN PERIODONTICS (NPI# 1679855761) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679855761 |
| Entity Type | Organization |
| Organization Name | MODERN PERIODONTICS |
| Practice Address |
2356 32nd Street Suite #100 Grand Rapids MI 49508-1510 |
| Mailing Address |
2356 32nd Street Suite #100 Grand Rapids MI 49508 |
| Practice Telephone | 6162415658 |
| Mailing Telephone | 6162415658 |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |
| Authorized Official Name | MRS. ERIN NICOLE MOERDYKE (OFFICE MANAGER) |
| Authorized Official Telephone | 6162415658 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
16791 | MI | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174942304 | Modern Periodontics | Dentist | 3434 Atlantic Blvd, Suite 1, Jacksonville, FL 32207 | 2014-04-15 |
| Street Address |
2356 32ND STREET SUITE #100 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49508-1510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063012367 | Jenna Brianne Labrecque | Social Worker | 2013 East Castle Dr, Suite B, Kentwood, MI 49508 | 2020-10-27 |
| 1881208809 | Morgan Paige Ballmann | Physical Therapy Assistant | 4150 Kalamazoo Ave. Se, Grand Rapids, MI 49508 | 2020-09-08 |
| 1699385740 | Jodie Lynn Robertson | Prosthetist | 3720 Eastern Se, Grand Rapids, MI 49508 | 2020-08-04 |
| 1003460874 | Derm Institute of West Michigan Plc | Dermatology | 6750 Kalamazoo Ave, Suites C & D, Grand Rapids, MI 49508 | 2019-07-30 |
| 1255801833 | Ikeia Tynika Hill | Licensed Practical Nurse | 1627 Lotus, Grand Rapids, MI 49508 | 2018-11-27 |
| 1326556838 | Araceli Contreras-hernandez | Behavior Technician | 3566 Eastern Ave. Se, Kentwood, MI 49508 | 2018-01-18 |
| 1881102788 | A Grand Rapids Senior Social Exchange and Adult Day Center | In Home Supportive Care | 3212 Eastern Ave Se, Grand Rapids, MI 49508 | 2018-01-14 |
| 1952827107 | Nupoint Services LLC | Clinic/Center | 1620 44th Street Se, Grand Rapids, MI 49508 | 2017-08-19 |
| 1710427695 | Embracing Life Afc | Custodial Care Facility | 1405 Forrester St S.e., Grand Rapids, MI 49508 | 2017-02-27 |
| 1083162838 | Katherine Berenice Campoverde Arevalo | Technician, Other | 1157 Billigs Ct Se, Ap# 1a, Grand Rapids, MI 49508 | 2016-09-21 |
| Find all providers in zip 49508 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316266000 | Christopher John Leja | Dentist | 4880 Cascade Rd Se Suite B, Grand Rapids, MI 49546 | 2010-05-20 |
| 1922293851 | James C. Papp, Dmd, Plc | Dentist | 4880 Cascade Rd Se Ste B, Grand Rapids, MI 49546-3701 | 2007-09-13 |
| 1386780666 | Kathleen Marie Eisin | Dentist | 6677 Crossings Drive Se, Suite #3, Grand Rapids, MI 49508 | 2007-01-30 |
| 1083704035 | Richard Alan Nezwek | Dentist | 4450 Cascade Rd Se, Grand Rapids, MI 49546-3697 | 2006-10-13 |
| 1619079365 | Norman R Wilhelmsen | Dentist | 255 Washington St Se, Grand Rapids, MI 49503-4350 | 2006-09-02 |
| 1770585879 | David Lamberts, Dds,pc | Dentist | 5510 Cascade Rd Se, Grand Rapids, MI 49546-6496 | 2005-06-02 |
| 1922266741 | Brian Cilla Dds Ms PC | Dentist | 1525 East Beltline Ne, Suite 201, Grand Rapids, MI 49525 | 2008-05-29 |
| 1649483751 | David M Lamberts | Dentist | 5510 Cascade Rd Se, Grand Rapids, MI 49546-6496 | 2007-05-07 |
| 1619196060 | Kathleen M. Eisin, Dds Ms Pllc | Dentist | 6677 Crossings Drive Se, Suite 3, Grand Rapids, MI 49508 | 2007-04-24 |
| 1275613838 | James Christopher Papp | Dentist | 4880 Cascade Rd Se, Suite B, Grand Rapids, MI 49546-3721 | 2006-10-17 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49508 |
Please comment or provide details below to improve the information on MODERN PERIODONTICS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.