Fuller Avenue Dental Associates
NPI 1639397615ActiveOrganization· Dentist, General Practice· Grand Rapids, MI
Dentist, General Practice in Grand Rapids, Michigan, registered in NPPES in April 2007. The authorized official on file is Shannon Marie Visscher-Worst, Office Manager.
Overview
| NPI | 1639397615 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 23, 2007 |
| Last updated in NPPES | Aug 22, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | 16615 | MI |
| Dentist, General Practice | 1223G0001X | 10428 | MI |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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