MODERN PERIODONTICS
NPI 1679855761
Dentist - Periodontics in Grand Rapids, MI

Q: What is Modern Periodontics's NPI number?

The NPI number for Modern Periodontics is 1679855761. It was assigned to this organization in the NPPES registry on September 14, 2011.

Q: What is Modern Periodontics's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Active since September 14, 2011

2356 32ND STREET, SUITE #100, GRAND RAPIDS, MI 49508(616) 241-5658 Get Directions Write a Review

NPPES record last updated: September 14, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Modern Periodontics NPPES

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

MODERN PERIODONTICS (NPI 1679855761) is a healthcare organization registered as a periodontics in Grand Rapids, Michigan and active in the NPI registry since September 2011. The organization lists Erin Nicole Moerdyke, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1679855761

Entity TypeOrganization

Primary Taxonomy1223P0300X

Legal Business NameMODERN PERIODONTICS

Location Address2356 32ND STREET, SUITE #100Grand Rapids, MI 49508-1510

Mailing Address2356 32nd Street, Suite #100Grand Rapids, MI 49508 · (616) 241-5658

Phone(616) 241-5658

Organization SubpartNo

Authorized OfficialErin Nicole MoerdykeOffice Manager · (616) 241-5658

Enumeration DateSeptember 14, 2011

✔ NPI 1679855761 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers

Taxonomy Code1223P0300X

License✔ Licensed in MI · 16791

Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

2356 32ND STREET, Grand Rapids, MI 49508

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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 SINGLE SPECIALTY GROUP

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 Modern Periodontics's NPI number?

The NPI number for Modern Periodontics is 1679855761. It was assigned to this organization in the NPPES registry on September 14, 2011.

Where is Modern Periodontics located?

Modern Periodontics is located at 2356 32nd Street Suite #100, Grand Rapids, MI 49508. The listed phone number is (616) 241-5658.

What is Modern Periodontics's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Modern Periodontics was last updated on September 14, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.