PROFESSIONAL DENTAL ASSOCIATES PC (NPI# 1750550109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750550109 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ASSOCIATES PC |
| Other Organization Name | JENSEN SHROYER ANDERSON PC |
| Practice Address |
98 Northern Avenue Barryton MI 49305 |
| Mailing Address |
98 Northern Avenue Po Box 244 Barryton MI 49305 |
| Practice Telephone | 9893827227 |
| Practice Fax Number | 9893827227 |
| Mailing Telephone | 9893827227 |
| Mailing Fax Number | 9893827227 |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2008-02-29 |
| Authorized Official Name | DR. KEVIN T MATHEWSON (DENTIST OWNER) |
| Authorized Official Telephone | 9893827227 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
16945 | MI | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
19296 | MA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
10102 | MI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BC BS | 8012370 | 01 |
| Other Name | Type Code |
|---|---|
| Jensen Shroyer Anderson PC | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154592285 | Professional Dental Associates PC | Dentist | 888 Michigan Ave, Baldwin, MI 49304 | 2008-03-17 |
| 1992863401 | Professional Dental Associates PC | Dentist | 415 South State Street, Big Rapids, MI 49307-2049 | 2006-12-05 |
| 1306915822 | Professional Dental Associates PC | Dentist | 3119 Newtown Ave, Suite 800, Astoria, NY 11102-1350 | 2006-11-07 |
| Street Address |
98 NORTHERN AVENUE |
| City | BARRYTON |
| State | MI |
| Zip Code | 49305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184700379 | Valerie Ruth Lucas | Nurse Practitioner | 425 Cherry Se, Grand Rapids, MI 49305 | 2006-10-31 |
| 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 |
|---|---|---|---|---|
| 1336749522 | Berman Family Dentistry Pllc | Dentist | 9430 S Main St Ste 1, Plymouth, MI 48170-4149 | 2020-10-28 |
| 1821696956 | Dream Dental Group Pllc | Dentist | 9600 Commerce Rd, Commerce Twp, MI 48382-4111 | 2020-10-12 |
| 1629675020 | Superior Family Dental | Dentist | 425 W Huron St Ste 140, Milford, MI 48381-2243 | 2020-10-08 |
| 1255948790 | Jamie L Hafke Dds Pllc | Dentist | 1955 N Pontiac Trl, Walled Lake, MI 48390-3157 | 2020-09-29 |
| 1942817812 | Maria Edith Cserhalmi | Dentist | 20618 Harper Ave., Harper Woods, MI 48225-1429 | 2020-09-25 |
| 1649886748 | Advanced Family Dentistry-plymouth Pllc | Dentist | 44644 Ann Arbor Rd W Ste F, Plymouth, MI 48170-4089 | 2020-09-23 |
| 1396351045 | Sandra Alias | Dentist | 27828 Westcott Crescent Cir, Farmington Hills, MI 48334-5314 | 2020-09-18 |
| 1265047641 | Michigan Implant Dental Center | Dentist | 28701 Plymouth Rd Ste B, Livonia, MI 48150-2421 | 2020-09-11 |
| 1366057929 | Dr. Leigh Ellen Snyder Dds | Dentist | 16869 E 14 Mile Rd, Fraser, MI 48026-2239 | 2020-09-10 |
| 1215541305 | Kevin P Cooper Dds PC | Dentist | 202 Brady Street, Sault Sainte Marie, MI 49783 | 2020-09-04 |
| Find all providers with the same taxonomy | ||||
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| 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.