Healthcare Provider Details

I. General information

NPI: 1104737527
Provider Name (Legal Business Name): BAKEMAN & KUCKHOFF DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2757 LEONARD ST NE STE 100
GRAND RAPIDS MI
49525-5807
US

IV. Provider business mailing address

2757 LEONARD ST NE STE 100
GRAND RAPIDS MI
49525-5807
US

V. Phone/Fax

Practice location:
  • Phone: 616-940-0481
  • Fax: 616-940-0486
Mailing address:
  • Phone: 616-940-0481
  • Fax: 616-940-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA KUCKHOFF
Title or Position: CO-OWNER
Credential: DMD
Phone: 616-940-0481