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FULLER AVENUE DENTAL ASSOCIATES
NPI 1639397615
Dentist - General Practice in Grand Rapids, MI

Active since April 23, 2007
2755 FULLER AVE NE, GRAND RAPIDS, MI 49505(616) 363-1136(616) 363-4345 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Fuller Avenue Dental Associates NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FULLER AVENUE DENTAL ASSOCIATES (NPI 1639397615) is a healthcare organization registered as a general practice in Grand Rapids, Michigan and active in the NPI registry since April 2007. The organization lists Shannon Marie Visscher-worst, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1639397615
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameFULLER AVENUE DENTAL ASSOCIATES
Location Address2755 FULLER AVE NEGrand Rapids, MI 49505-3780
Mailing Address2755 Fuller Ave NeGrand Rapids, MI 49505-3780 · (616) 363-1136 · Fax (616) 363-4345
Phone(616) 363-1136
Fax(616) 363-4345
Organization SubpartNo
Authorized OfficialShannon Marie Visscher-worstOffice Manager · (616) 363-1136
Enumeration DateApril 23, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1639397615 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Licenses✔ Licensed in MI · 16615✔ Licensed in MI · 10428
Definition

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.

2755 FULLER AVE NE, Grand Rapids, MI 49505
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ESTHER JIMENEZ D.D.S
Dentist (General Practice)
2755 FULLER AVE NE
GRAND RAPIDS, MI 49505
Kent County (616) 363-1136
HARVESTER DENTAL
Dentist (General Practice)
2755 FULLER AVE NE
GRAND RAPIDS, MI 49505
Kent County (616) 363-1136

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fuller Avenue Dental Associates's NPI number?

The NPI number for Fuller Avenue Dental Associates is 1639397615. It was assigned to this organization in the NPPES registry on April 23, 2007.

Where is Fuller Avenue Dental Associates located?

Fuller Avenue Dental Associates is located at 2755 Fuller Ave NE, Grand Rapids, MI 49505. The listed phone number is (616) 363-1136.

What is Fuller Avenue Dental Associates's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Fuller Avenue Dental Associates was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.