Active NPI
Mohanad Ballani
- General Practice Dentistry
- Flint, MI
National Provider Identifier
1053635458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901020063
- Practice address
- G3538 Miller Rd
Ste a
Flint, MI 48507-1271 - Phone
- (810) 424-0400
- NPI assigned
- Mar 15, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901020063 | MI | Primary |
Addresses
Primary practice location
G3538 Miller Rd
Ste a
Flint, MI 48507-1271
Mailing address
PO Box 3189
Syracuse, NY 13220-3189
Phone (315) 454-6000
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 |
|---|---|---|---|---|
| I20160219001434 | MI | Order and Referring Only - Dentist | 9931404589 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901020063 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268611200000",
"number": "1053635458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3189",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132203189",
"telephone_number": "315-454-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "G3538 MILLER RD",
"address_2": "STE A",
"city": "FLINT",
"state": "MI",
"postal_code": "485071271",
"telephone_number": "810-424-0400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLANI",
"first_name": "MOHANAD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-15",
"last_updated": "2010-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901020063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; 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.