RIVERTOWN DENTAL EXCELLENCE
NPI 1558633909
Dentist in Grandville, MI
NPI Status: Active since February 01, 2012
Contact Information
4565 WILSON AVE SW
SUITE 2A
GRANDVILLE, MI
ZIP 49418
Phone: (616) 538-0770
Fax: (616) 538-0359
- Organization
- Dentist
- Accepts Insurance
- CLIA Number: 23D2205132
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 12-11-2026
About RIVERTOWN DENTAL EXCELLENCE
This page provides the complete NPI Profile along with additional information for Rivertown Dental Excellence, a provider established in Grandville, Michigan operating as a Dentist. The healthcare provider is registered in the NPI registry with number 1558633909 assigned on February 2012. The practitioner's primary taxonomy code is 122300000X with license number 2901019772 (MI). The provider is registered as an organization and their NPI record was last updated 14 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Dr. Jared M Van Ittersum D.d.s. (Owner)
- NPI
- 1558633909
- Provider Name
- RIVERTOWN DENTAL EXCELLENCE
- Entity Type
- Organization
- Location Address
- 4565 WILSON AVE SW SUITE 2A GRANDVILLE, MI 49418
- Location Phone
- (616) 538-0770
- Location Fax
- (616) 538-0359
- Mailing Address
- 4565 WILSON AVE SW SUITE 2A GRANDVILLE, MI 49418
- Mailing Phone
- (616) 538-0770
- Mailing Fax
- (616) 538-0359
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-01-2012
- Last Update Date
- 02-01-2012
- Code Navigator
A dentist like Rivertown Dental Excellence is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dentist
- Taxonomy Code
- 122300000X
- Type
- Dental Providers
- License No.
- 2901019772
- License State
- MI
- Taxonomy Description
- A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Blue Dental EPO 80/50/50 (0/0/0) - EPO
- Blue Dental PPO 100/50/50 (50/50/50) - PPO
- Blue Dental PPO 100/70/50 (80/60/50) - PPO
- Blue Dental PPO 80/50/50 (50/50/50) - PPO
- Blue Dental PPO Pediatric 80/50/50 (50/50/50) - PPO
- Blue Dental PPO Plus 80/60/50 - PPO
- Lone Star - Smile Now - PPO
- Smile Now Arizona - No Waiting Period PPO - PPO
- Smile Now Michigan - No Waiting Period PPO - PPO
- Smile Now Ohio - No Waiting Period PPO - PPO
- Smile Now Texas- No Waiting Period Plan - PPO
- Smile Now Utah - No Waiting Period PPO - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 23D2205132
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- December 12, 2024
- Certificate Expiration Date
- December 11, 2026
- Laboratory Director
- ERIC KIRBY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Rivertown Dental Excellence to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1558633909, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 61. The final step is to find the difference between that total and the next multiple of ten (70 - 61 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 61 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 10 providers are registered at the same or a nearby location.
GRANDVILLE, MI 49418
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1558633909, enumerated as an "organization" on February 01, 2012.
The provider is located at 4565 WILSON AVE SW SUITE 2A GRANDVILLE, MI 49418 and the phone number is (616) 538-0770.
Dentist with taxonomy code 122300000X.
The provider might be accepting Accepts: Blue Cross Blue Shield of Michigan Mutual. Please consult your insurance carrier or call the provider to verify.
