Healthcare Provider Details

I. General information

NPI: 1417896739
Provider Name (Legal Business Name): JESSICA NICOLE MEYER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 DIVISION AVE S
GRAND RAPIDS MI
49507-3029
US

IV. Provider business mailing address

229 HAMPTON AVE SE
GRAND RAPIDS MI
49506-1705
US

V. Phone/Fax

Practice location:
  • Phone: 616-475-8446
  • Fax:
Mailing address:
  • Phone: 217-415-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902017335
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: