NPIMap

Organization Active NPI

St.George Family Dentistry P.C

  • General Practice Dentistry
  • Oak Park, MI
National Provider Identifier
1023261617
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901018305 Issued in IL
Legal business name
ST.GEORGE FAMILY DENTISTRY P.C
Practice address
10470 W 9 Mile Rd
Oak Park, MI 48237-2914
Phone
(248) 548-2210
Fax
(248) 548-1769
NPI assigned
Oct 28, 2008
Last updated
Oct 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alaa K Hermiz, D.M.DNPI 1013060375
Title
Dentist
Phone
(248) 548-2210

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901018305 IL Primary

Addresses

Primary practice location

10470 W 9 Mile Rd
Oak Park, MI 48237-2914

Mailing address

10470 W 9 Mile Rd
Oak Park, MI 48237-2914
Phone (248) 548-2210

Other identifiers 1

IdentifierTypeStateIssuer
4547942MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1023261617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 W 9 MILE RD",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372914",
            "telephone_number": "248-548-2210",
            "fax_number": "248-548-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10470 W 9 MILE RD",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372914",
            "telephone_number": "248-548-2210",
            "fax_number": "248-548-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST.GEORGE FAMILY DENTISTRY P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "HERMIZ",
        "authorized_official_first_name": "ALAA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "248-548-2210",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "2901018305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4547942",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.

Verify at the official NPI Registry.