Individual provider Active NPI

Brian Myers

  • Dentist
  • Grand Blanc, MI
National Provider Identifier
1063607844
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901019429 Issued in MI
Practice address
9499 Holly Rd
Grand Blanc, MI 48439
Phone
(810) 694-7450
NPI assigned
Sep 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901019429 MI Primary

Addresses

Primary practice location

9499 Holly Rd
Grand Blanc, MI 48439

Mailing address

9499 Holly Rd
Grand Blanc, MI 48439-8351

Other practice location 1

21537 Harper Ave
Saint Clair Shores, MI 48080-2207
Phone (586) 779-0150

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161227000523 MI Order and Referring Only - DentistPractitioner - Dentist 6800177239

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901019429MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Goldberg and Myers Dentistry, PLC Current Accepting new patients

Locations

9499 Holly Rd
Grand Blanc, MI 48439
Phone (810) 694-7450

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1063607844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9499 HOLLY RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9499 HOLLY RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "48439",
            "telephone_number": "810-694-7450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21537 Harper Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480802207",
            "country_code": "US",
            "telephone_number": "586-779-0150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MYERS",
        "first_name": "BRIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-13",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

Verify at the official NPI Registry.