NPIMap

Organization Active NPI

Oshtemo Family Dentistry, PC

  • Dentist
  • Kalamazoo, MI
National Provider Identifier
1053484253
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901012099 Issued in MI
Legal business name
OSHTEMO FAMILY DENTISTRY, PC
Practice address
5917 Stadium Dr
Kalamazoo, MI 49009-3017
Phone
(269) 372-1042
Fax
(269) 372-9962
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Richard Kevin Bannow, D.D.S.
Title
President
Phone
(269) 372-1042

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2901012099 MI Primary

Addresses

Primary practice location

5917 Stadium Dr
Kalamazoo, MI 49009-3017

Mailing address

5917 Stadium Dr
Kalamazoo, MI 49009-3017
Phone (269) 372-1042

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053484253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5917 STADIUM DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093017",
            "telephone_number": "269-372-1042",
            "fax_number": "269-372-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5917 STADIUM DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093017",
            "telephone_number": "269-372-1042",
            "fax_number": "269-372-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSHTEMO FAMILY DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BANNOW",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-372-1042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.