PROFESSIONAL DENTAL ASSOCIATES PC (NPI# 1154592285) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154592285 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ASSOCIATES PC |
| Other Organization Name | JENSEN SHROGER ANDERSON PC |
| Practice Address |
888 Michigan Ave Baldwin MI 49304 |
| Mailing Address |
Po Box 152 888 Michigan Ave Baldwin MI 49304 |
| Practice Telephone | 2317457231 |
| Practice Fax Number | 2317457246 |
| Mailing Telephone | 2317457231 |
| Mailing Fax Number | 2317457246 |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2008-03-17 |
| Authorized Official Name | DR. KEVIN T MATHEWSON (DENTIST OWNER) |
| Authorized Official Telephone | 2317963571 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | PROFESSIONAL DENTAL ASSOCIATES PC |
| 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 | BCBS | 8012380 | 01 |
| MI | UCCI | 2007556 | 01 |
| Other Name | Type Code |
|---|---|
| Jensen Shroger Anderson PC | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750550109 | Professional Dental Associates PC | Dentist | 98 Northern Avenue, Barryton, MI 49305 | 2008-02-29 |
| 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 |
888 MICHIGAN AVE |
| City | BALDWIN |
| State | MI |
| Zip Code | 49304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437250941 | Pamela Sue Alley | Nurse Practitioner | 1234 Washington Ave, Vision of Health, Baldwin, MI 49304 | 2006-09-26 |
| 1902308463 | Baldwin Family Health Care | Clinic/Center | 1101 Washington St, Baldwin, MI 49304 | 2018-03-01 |
| 1528499233 | Lisa Joan West | Nurse Practitioner | 1615 Michigan Ave, Baldwin, MI 49304 | 2013-12-05 |
| 1578713798 | Tracy Lynne Moody | Nurse Practitioner | 1615 Michigan Ave, Baldwin, MI 49304 | 2008-09-24 |
| 1801016613 | Baldwin Family Health Care | Clinic/Center | 525 4th St, Baldwin, MI 49304 | 2007-04-26 |
| 1932248143 | John Carl Hodges | Counselor | 1615 Michigan Ave, Baldwin, MI 49304 | 2007-02-05 |
| 1467468819 | Maurice James Sutton | Dentist | 1615 Michigan Ave, Balduoin, MI 49304 | 2006-07-31 |
| 1376559724 | Oliver D Grin | Neurological Surgery | 1615 Michigan Ave, Baldwin, MI 49304 | 2006-07-31 |
| 1508891813 | Stephen Kozak | Dentist | 1615 Michigan Ave, Baldwin, MI 49304 | 2006-07-12 |
| 1689609992 | Donald H French | Dentist | 1615 Michigan Ave, Baldwin, MI 49304 | 2006-07-12 |
| Find all providers in zip 49304 | ||||
| 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 |
|---|---|---|---|---|
| 1053636407 | Ivylyn Donya Davis-bell | Dentist | 1900 North Grand Avenue, Suite 6, Baldwin, NY 11510 | 2010-03-29 |
| 1871717835 | Alisa Marie Onken | Dentist | 1460 10th Ave Ste B, Baldwin, WI 54002-9342 | 2007-04-12 |
| 1598803256 | Raymond Leroy Price | Dentist | 1730 8th Avenue, Baldwin, WI 54002-0455 | 2007-02-02 |
| 1295894541 | Paul France Cosgrove | Dentist | 1700 Grand Ave, Baldwin, NY 11510 | 2006-12-06 |
| 1194894907 | David E Scott | Dentist | 1460 10th Ave, Suite B, Baldwin, WI 54002-9342 | 2006-11-07 |
| 1952325425 | Marvin J. Nathanson | Dentist | 3369 Milburn Ave, Baldwin, NY 11510-5146 | 2006-07-27 |
| 1174526164 | David A Grossman | Dentist | 824 Merrick Rd, Baldwin, NY 11510-3354 | 2005-05-23 |
| 1306408695 | Sasha-gay Haynes Mcbride | Dentist | 1615 Michigan Ave, Baldwin, MI 49304-7984 | 2019-07-08 |
| 1174180574 | Michael Jordan Halcomb | Dentist | 1615 Michigan Ave, Baldwin, MI 49304-7984 | 2019-05-22 |
| 1558854356 | Akosua S Appiagyei | Dentist | 1615 Michigan Ave, Baldwin, MI 49304-7984 | 2018-06-07 |
| Find all providers in BALDWIN | ||||
Please comment or provide details below to improve the information on PROFESSIONAL DENTAL ASSOCIATES PC.
| 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.