NPIMap

Organization Active NPI

Family Dental Services PC

  • General Practice Dentistry
  • Saint Johns, MI
National Provider Identifier
1053525899
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13432 Issued in MI
Legal business name
FAMILY DENTAL SERVICES PC
Practice address
911 E State St
Suite C
Saint Johns, MI 48879-1684
Phone
(989) 224-2379
NPI assigned
May 10, 2007
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. Mark John Connelly, DDSNPI 1235168683
Title
Dentist
Phone
(989) 224-2379

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 13432 MI Primary

Addresses

Primary practice location

911 E State St
Suite C
Saint Johns, MI 48879-1684

Mailing address

911 E State St
Suite C
Saint Johns, MI 48879-1684
Phone (989) 224-2379

Other names 1

  • St. Johns Dental Care Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053525899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 E STATE ST",
            "address_2": "SUITE C",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488791684",
            "telephone_number": "989-224-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 E STATE ST",
            "address_2": "SUITE C",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488791684",
            "telephone_number": "989-224-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONNELLY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "989-224-2379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "13432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Johns Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Johns, 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.