Active NPI
Mark Steven Devuyst, DDS
- General Practice Dentistry
- Clinton Township, MI
National Provider Identifier
1003865221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 18495
- Practice address
- 42855 Garfield Rd
Ste.107
Clinton Township, MI 48038-5027 - Phone
- (586) 416-1625
- Fax
- (586) 416-1630
- NPI assigned
- May 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 18495 | MI | Primary |
Addresses
Primary practice location
42855 Garfield Rd
Ste.107
Clinton Township, MI 48038-5027
Mailing address
12563 Lennry Ave
Shelby TWP, MI 48315-1759
Phone (586) 610-6094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150320000643 | MI | Order and Referring Only - Other (Non-Physician) | 3779800230 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18495 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448236800000",
"number": "1003865221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12563 LENNRY AVE",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483151759",
"telephone_number": "586-610-6094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42855 GARFIELD RD",
"address_2": "STE.107",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480385027",
"telephone_number": "586-416-1625",
"fax_number": "586-416-1630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVUYST",
"first_name": "MARK",
"middle_name": "STEVEN",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-06",
"last_updated": "2015-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "18495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.