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Deactivated NPI 1003815655 Deactivated / Inactive NPI Male Practitioner

Dr. Randy James Breen , DDS

Dentist - General Practice • Grand Rapids, MI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Randy Breen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 17, 2005
NPI Deactivation Date March 18, 2006
Total Practice Duration ~1 Years of Practice (2005 – 2006)

Professional Overview & Biography Verified Profile Summary

Dr. Randy Breen, DDS was a registered Dentist - General Practice practicing in Grand Rapids, MI. Throughout an active medical career spanning 1 years, Dr. Breen provided care at the practice location at 515 LAKESIDE DR SE until profile deactivation on 2006-03-18.

Practice Location & Contact Primary Location

Practice Address

515 Lakeside Dr Se
#208

Grand Rapids, MI 495062931

Telephone 6164549091
Fax 6164541159
Associated Practice Facility / Clinic
🏢 Thomas A Malec Md Pc Facility NPI 1346414620

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Grand Rapids, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 5.0 Yrs
State Avg: 15.8 Yrs
Regional Practice Density
174 Specialists

Practicing in Grand Rapids, MI (4360 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MI 2901014055

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1619961778

Doctor of Medicine (M.D.), PC

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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Updated Practice Location July 08, 2007

Registered at 515 LAKESIDE DR SE, #208, GRAND RAPIDS, MI 495062931 (Tel: 6164549091)

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Updated Business Mailing Address July 08, 2007

Registered at 2435 ROLLING MEADOW DR NE, BELMONT, MI 493069332 (Tel: 6168639515)

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Provider Name / Credentials Updated July 08, 2007

Recorded as RANDY BREEN, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #2901014055 in MI)

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NPI Profile Reactivated March 24, 2006

Record officially reactivated for active practice on March 24, 2006

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NPI Profile Deactivated March 18, 2006

Record deactivated on March 18, 2006

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Initial NPI Registration & Enumeration July 17, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1003815655
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 17, 2005
Last Update: July 13, 2026
Deactivation Date: March 18, 2006
Sole Proprietor: No

Mailing Address

2435 Rolling Meadow Dr Ne

Belmont, MI 493069332

Phone: 6168639515

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.