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STUART PETTIJOHN DDS
NPI 1710207097
Dentist in Grand Rapids, MI

Active since June 09, 2010
4500 CASCADE RD SE STE 100, GRAND RAPIDS, MI 49546(616) 942-8301 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 21, 2022, Mar 17, 2018, Sep 13, 2017 (3 updates tracked since 2017).

About Stuart Pettijohn Dds NPPES

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

STUART PETTIJOHN DDS (NPI 1710207097) is an individual dentist in Grand Rapids, Michigan, licensed in Michigan (2901020216) and active in the NPI registry since June 2010. He maintains a secondary practice location in Adrian.

NPPES Registry Identity

NPI1710207097
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameSTUART PETTIJOHNCredential: DDS
Location Address4500 CASCADE RD SE STE 100Grand Rapids, MI 49546-3665
Mailing Address4500 Cascade Rd Se Ste 100Grand Rapids, MI 49546-3665 · (616) 942-8301
Phone(616) 942-8301
Sole ProprietorNo
Enumeration DateJune 9, 2010
Last NPPES UpdateJuly 21, 20223 updates tracked since enumeration
✔ NPI 1710207097 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MI · 2901020216
Definition
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.
4500 CASCADE RD SE STE 100, Grand Rapids, MI 49546
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Secondary Practice Location 1

Location 1128 S Broad StAdrian, MI 49221-2723 · Phone (517) 266-0651

Other Providers at the Same Location NPPES

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

STUART PETTIJOHN DDS PLLC
Dentist
4500 CASCADE RD SE STE 100
GRAND RAPIDS, MI 49546
Kent County (616) 942-8301

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 Stuart Pettijohn's NPI number?

The NPI number for Stuart Pettijohn is 1710207097. It was assigned to this individual provider in the NPPES registry on June 9, 2010.

Where is Stuart Pettijohn located?

Stuart Pettijohn practices at 4500 Cascade Rd SE Ste 100, Grand Rapids, MI 49546. The listed phone number is (616) 942-8301.

What is Stuart Pettijohn's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Stuart Pettijohn was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.