PORT PEDIATRIC DENTISTRY PC (NPI# 1669080651) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669080651 |
| Entity Type | Organization |
| Organization Name | PORT PEDIATRIC DENTISTRY PC |
| Practice Address |
291 W Lakewood Blvd Holland MI 49424-1969 |
| Practice Telephone | 6163921100 |
| Practice Fax Number | 6163961117 |
| Mailing Telephone | 6163921100 |
| Mailing Fax Number | 6163961117 |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-07-16 |
| Authorized Official Name | DR. SUZANNE KRISTEN PORT (DENTIST/OWNER) |
| Authorized Official Telephone | 6163921100 |
| Authorized Official Credential | DDS,MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Street Address |
291 W LAKEWOOD BLVD |
| City | HOLLAND |
| State | MI |
| Zip Code | 49424-1969 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700925690 | Suzanne K Port | Dentist | 291 W Lakewood Blvd, Holland, MI 49424 | 2007-02-06 |
| 1528189867 | Thomas Chase Phares | Dentist | 291 W Lakewood Blvd, Holland, MI 49424-1969 | 2007-04-03 |
| 1245351592 | Phares Family Dentistry | Dentist | 291 W Lakewood Blvd, Holland, MI 49424-1969 | 2007-04-03 |
| 1386788610 | Philip C Wisniewski | Dentist | 291 W Lakewood Blvd, Holland, MI 49424-1969 | 2007-02-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194290999 | Anderson Family and Cosmetic Dentistry | Dentist | 453 136th Ave., Holland, MI 49424 | 2018-10-08 |
| 1487139663 | Maria C. Hoekstra Dds, P.C. | Dentist | 1121 Ottawa Beach Road, Suite 100, Holland, MI 49424 | 2018-10-03 |
| 1871024000 | Derek Schaaf | Rehabilitation Practitioner | 13835 Foxtrail Dr., Holland, MI 49424 | 2017-03-21 |
| 1699227397 | Tabitha Margritz | Optometrist | 2279 N Park Drive #910, Holland, MI 49424 | 2016-10-28 |
| 1619373701 | Miller Chiropractic LLC | Chiropractor | 84 East Lakewood Boulevard, Holland, MI 49424 | 2014-11-17 |
| 1891107611 | Nathan B. Poel | Dentist | 1180 Ottawa Beach Rd, Suite E, Holland, MI 49424 | 2014-05-28 |
| 1477990802 | Jeanine Hamilton | Speech-Language Pathologist | 1576 Eb Creek Dr., Holland, MI 49424 | 2013-05-24 |
| 1194062638 | Stefan John Kuipers | Physician Assistant | 3100 Wellness Dr, Holland, MI 49424 | 2013-01-03 |
| 1902155690 | Benjamin Eovaldi | General Practice | 376 Mayfair St., Holland, MI 49424 | 2012-09-10 |
| 1295017929 | Employee Assistance Center Garden | Psychologist | 372 Garden, Holland, MI 49424 | 2011-09-20 |
| Find all providers in zip 49424 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063987725 | Little Red Pediatric Dentistry, Plc | Dentist | 12723 N Bellwood Dr Ste 20, Holland, MI 49424-7275 | 2018-10-09 |
| 1588799175 | Thomas Joel Bouwens | Dentist | 844 South Washington Ave, Holland, MI 49423-7195 | 2007-02-22 |
| 1700925690 | Suzanne K Port | Dentist | 291 W Lakewood Blvd, Holland, MI 49424 | 2007-02-06 |
| 1942327259 | West Michigan Pediatric Dentistry, Pllc | Dentist | 844 Washington Ave, Suite 4100, Holland, MI 49423-7195 | 2007-03-23 |
| 1811069198 | Daniel L Bolt | Dentist | 844 S Washington Ave, Suite 4100, Holland, MI 49423 | 2006-11-14 |
| 1720150006 | Robert L Sterken | Dentist | 844 S Washington Ave, Suite 4100, Holland, MI 49423 | 2006-11-14 |
| 1750316451 | Myriam Cerezo-falco | Dentist | 295 Buck Road, Suite 201, Holland, PA 18966-1748 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033717558 | Discover Smiles Pediatric Dentistry | Dentist | 2277 Science Pkwy Ste 2, Okemos, MI 48864-2551 | 2020-10-16 |
| 1740898873 | Megan E Stowers Dds Ms Plc | Dentist | 7459 Middlebelt Rd Ste 1, West Bloomfield, MI 48322-4184 | 2020-07-15 |
| 1447884069 | Jocelyn M. Robelli Dds, Ms, Pllc | Dentist | 18245 E 10 Mile Rd Ste 110, Roseville, MI 48066-5807 | 2020-02-24 |
| 1457914038 | Mitten Kids Dentistry Caledonia Plc | Dentist | 6477 Cherry Meadow Dr Se Ste 4, Caledonia, MI 49316-7351 | 2019-04-18 |
| 1780143982 | Childrens Dental Specialists of Hazel Park Pllc | Dentist | 22241 John R Rd, Hazel Park, MI 48030-1716 | 2019-03-18 |
| 1487128120 | Dental Group Associates PC | Dentist | 4505 Cascade Rd Se # B, Grand Rapids, MI 49546-8381 | 2019-01-16 |
| 1184194433 | Pediatric Dental Specialists of West Michigan | Dentist | 2155 E Paris Ave Se Ste 120, Grand Rapids, MI 49546-6142 | 2018-11-29 |
| 1811465990 | Kingma Pediatric Dentistry Pllc | Dentist | 1179 E Paris Ave Se Ste 130, Grand Rapids, MI 49546-3682 | 2018-11-07 |
| 1407322548 | Great Lakes Bay Pediatric Dentistry, Plc | Dentist | 5605 Colony Dr N Ste 2, Saginaw, MI 48638-7187 | 2018-10-16 |
| 1922505403 | Hannah Rutten | Dentist | 3890 Charlevoix Rd, Petoskey, MI 49770-8422 | 2018-04-10 |
| 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.