Active NPI
Hana Gadalla
- Periodontics
- Detroit, MI
National Provider Identifier
1023414240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- L443857
- Practice address
- 2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576 - Phone
- (313) 494-6660
- Fax
- (313) 494-6666
- NPI assigned
- Nov 16, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | L443857 | MI | Primary |
Addresses
Primary practice location
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Mailing address
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Phone (313) 494-6660
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: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160504001356 | MI | Order and Referring Only - Other (Physician) | 3072812510 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L443857 | MI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416096000000",
"number": "1023414240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576",
"telephone_number": "313-494-6660",
"fax_number": "313-494-6666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576",
"telephone_number": "313-494-6660",
"fax_number": "313-494-6666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GADALLA",
"first_name": "HANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-11-16",
"last_updated": "2014-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "L443857",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2014; 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.