Jae Joon Ma, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901601091 Issued in MI

Practice address

26113 Hoover Rd
Warren, MI 48089-1147

Phone

(586) 393-5686

NPI assigned

Oct 4, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Pro Dental Mi 1 PC

  • General Practice Dentistry
  • Warren, MI
  • NPI 1144057423
  NPD

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

{
    "created_epoch": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1023780301",
    "addresses": [
        {
            "country_code": "CA",
            "country_name": "Canada",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "515 RIVERSIDE DRIVE WEST",
            "address_2": "#1306",
            "city": "WINDSOR",
            "state": "ON",
            "postal_code": "N9A 7C3"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26113 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480891147",
            "telephone_number": "586-393-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "JAE JOON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901601091",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901601091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jared Lutsic, DO
• Luxottica Retail North America Inc
• M M E and Supplies Inc
• M Run LLC
• M.D. Optical, Warren LTD.
• Maan Askar M.D. P.C
• Maan Jamal M.D.P.C.
• Tyler Mabie
• Courtney Mabins
• Jeremy L Mable, PHARMD

• General Practice Dentistry in Warren, MI
• Providers in Warren, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; 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.