DR. BRUCE ARDEN JACKSON II (NPI# 1720039878) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720039878 |
| Entity Type | Individual |
| Full Name | DR. BRUCE ARDEN JACKSON II |
| Credential | DDS |
| Practice Address |
4829 E Beltline Ave Ne Grand Rapids MI 49525-9747 |
| Practice Telephone | 6163638707 |
| Practice Fax Number | 6163630390 |
| Mailing Telephone | 6163638707 |
| Mailing Fax Number | 6163630390 |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2020-09-02 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
13162 | MI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 4066190 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992039291 | Bruce C. Jackson | Chiropractor | 201 Brighton Park Blvd., Ste. 4, Frankfort, KY 40601-8447 | 2009-09-21 |
| 1851430532 | Bruce W Jackson | Dentist | 111 Lilac Dr, Liberal, KS 67901 | 2007-02-06 |
| 1124072087 | Bruce L Jackson | Physician Assistant | 15863 Kasota Rd, Apple Valley, CA 92307-4507 | 2006-05-22 |
| 1598133571 | Bruce Jackson | Registered Nurse | 2828 1st Ave Ste 400, Huntington, WV 25702-1236 | 2015-09-09 |
| 1467711986 | Bruce Jackson | Case Manager/Care Coordinator | 5715 S Broadway, Los Angeles, CA 90037-4131 | 2012-05-04 |
| 1598819567 | Bruce E Jackson | Counselor | 5455 Almira Dr Se, Bremerton, WA 98311-8330 | 2007-01-23 |
| 1609883438 | Bruce K Jackson | Internal Medicine | 520 N Prospect Ave, Ste. 300, Redondo Beach, CA 90277-3041 | 2006-08-02 |
| Street Address |
4829 E BELTLINE AVE NE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49525-9747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457333098 | Kristie Sue Buchholz | Nurse Practitioner | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2005-11-18 |
| 1639783137 | Bruce A. Jackson II, Dds, Plc | Clinic/Center | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2020-09-02 |
| 1033730213 | Rhett Baylor Jackson | Dentist | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2020-04-29 |
| 1831727585 | Rockford Speech Therapy | Speech-Language Pathologist | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2020-03-30 |
| 1205396538 | Susan Missad Counseling | Psychologist | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2019-03-22 |
| 1861971145 | Maria Herrala | Social Worker | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2018-08-08 |
| 1649729286 | Lynnae Dawn Guffie | Social Worker | 4829 E Beltline Ave Ne, Grand Rapids, MI 49525-9747 | 2016-09-23 |
| 1194182469 | Jonathan Mulder | Counselor | 4829 E Beltline Ave Ne, Suite 103, Grand Rapids, MI 49525-9747 | 2016-01-18 |
| 1184019077 | Cognitive Therapy of Grand Rapids | Psychologist | 4829 E Beltline Ave Ne, Bldg 1 Suite 100, Grand Rapids, MI 49525-9747 | 2015-03-30 |
| 1871912709 | Angela Schmidt | Psychologist | 4829 E Beltline Ave Ne, Building 1, Suite 100, Grand Rapids, MI 49525-9747 | 2014-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053928507 | Therapy With Nicole Pllc | Community/Behavioral Health | 4867 E. Beltline Ave. Ne, Building #1 Lower Level, Grand Rapids, MI 49525 | 2020-09-29 |
| 1184242760 | Christian Healthcare Specialists, Inc. | Obstetrics & Gynecology | 3322 Beltline Court Ne, Suite 1, Grand Rapids, MI 49525 | 2020-07-09 |
| 1174154645 | Amy Vanderslik | Case Manager/Care Coordinator | 3310 Eaglecrest Park Dr. Ne, Suite 100, Grand Rapids, MI 49525 | 2020-02-03 |
| 1477195246 | Epic Discoveries LLC | Counselor | 4867 E. Beltline Ave Ne, Grand Rapids, MI 49525 | 2019-10-14 |
| 1598228959 | Kim Scherencel Lmsw Counseling | Social Worker | 3280 Beltline Ne, Grand Rapids, MI 49525 | 2019-04-11 |
| 1821558958 | Mindful Trajectories | Social Worker | 3280 Beltlne Ct Ne, Grand Rapids, MI 49525 | 2019-03-24 |
| 1104380518 | Julianne Lettinga, Ma Lpc Counseling | Counselor | 3280 East Beltline Ct Ne, Grand Rapids, MI 49525 | 2019-01-30 |
| 1396227229 | Christopher Scot Doucette | Social Worker | 2064 Airway St Ne, Grand Rapids, MI 49525 | 2018-09-06 |
| 1568976017 | Amy K. Deyoung, Dds, Ms, PC Pediatric Dentistry | Dentist | 3297 Eagle Run Dr. Ne, Grand Rapids, MI 49525 | 2017-11-20 |
| 1407389604 | Kelly Jo Crabb | Social Worker | 4829 E Beltline Ave Ne Ste 100, Grand Rapids, MI 49525 | 2017-04-05 |
| Find all providers in zip 49525 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265059570 | Samuel T. Bander, Dds, Plc | Dentist | 1151 E Paris Ave Se Ste 100, Grand Rapids, MI 49546-8369 | 2020-07-02 |
| 1295360428 | Dj Edgerle, Dds, PC | Dentist | 751 Kenmoor Ave Se Ste G, Grand Rapids, MI 49546-2391 | 2020-03-09 |
| 1639638265 | Mark E Peterson, Dds | Dentist | 2440 Gaynor Ave Nw, Grand Rapids, MI 49544-1830 | 2019-03-13 |
| 1811463730 | Ryan C. Van Haren, Dds Pllc | Dentist | 2144 E Paris Ave Se Ste 110, Grand Rapids, MI 49546-6111 | 2018-10-18 |
| 1386138881 | Jayson Lynn Clore | Dentist | 334 68th St Sw, Grand Rapids, MI 49548-7179 | 2018-06-18 |
| 1154788230 | Kb Family Dentistry Plc | Dentist | 3167 Kalamazoo Ave Se # 1, Grand Rapids, MI 49508-1475 | 2016-01-21 |
| 1821471616 | Healthy Smile Plc | Dentist | 2021 44th St Sw, Grand Rapids, MI 49508 | 2015-06-30 |
| 1841694387 | Jerry B. Mulder Dds Plc | Dentist | 515 Michigan St Ne Ste 202, Grand Rapids, MI 49503-5721 | 2014-10-13 |
| 1609277854 | Alexis Neuman | Dentist | 3930 Burton St Se, Grand Rapids, MI 49546-5819 | 2014-09-08 |
| 1124439476 | Bryton Mansfield | Dentist | 1636 Leonard St Nw, Grand Rapids, MI 49504-3950 | 2014-05-08 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49525 |
Please comment or provide details below to improve the information on DR. BRUCE ARDEN JACKSON II.
| 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.