Active NPI
Benjamin Jarvis Seymour, DDS
- General Practice Dentistry
- Cadillac, MI
National Provider Identifier
1003981002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 29010-19403
- Practice address
- 504 Haynes St
Cadillac, MI 49601-1809 - Phone
- (231) 775-6531
- Fax
- (231) 775-6431
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 29010-19403 | MI | Primary |
Addresses
Primary practice location
504 Haynes St
Cadillac, MI 49601-1809
Mailing address
504 Haynes St
Cadillac, MI 49601-1809
Phone (231) 775-6531
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4918174 | Other | MI | MEDICAID |
| 4919510 | Other | MI | MEDICAID |
| 4919500 | Other | MI | MEDICAID |
| D194030 | Other | MI | BCBS |
| 1883242 | Other | MI | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29010-19403 | MI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Dental Associates PC | General Practice | Past | Accepting new patients |
| Northern Quality Dental | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Big Rapids, MI
- NPI 1992863401
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217376000000",
"number": "1003981002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 HAYNES ST",
"city": "CADILLAC",
"state": "MI",
"postal_code": "496011809",
"telephone_number": "231-775-6531",
"fax_number": "231-775-6431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 HAYNES ST",
"city": "CADILLAC",
"state": "MI",
"postal_code": "496011809",
"telephone_number": "231-775-6531",
"fax_number": "231-775-6431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEYMOUR",
"first_name": "BENJAMIN",
"middle_name": "JARVIS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2008-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "29010-19403",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "4918174",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "4919510",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "4919500",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "D194030",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "1883242",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cadillac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.