Special Dental PC

Primary specialty

DentistTaxonomy code 122300000X

License

2901012438 Issued in MI

Legal business name

SPECIAL DENTAL PC

Practice address

27201 Ryan Rd
Warren, MI 48092

Phone

(586) 558-8004

NPI assigned

Sep 25, 2014

Organization subpart

No

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

Authorized official

Name

Tina Wilder

Title

Reg Manager

Phone

(313) 342-1997

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411603200000",
    "number": "1083016711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27201 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480925127",
            "telephone_number": "586-558-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27201 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48092",
            "telephone_number": "586-558-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIAL DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-25",
        "last_updated": "2014-09-25",
        "status": "A",
        "authorized_official_last_name": "WILDER",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "REG MANAGER",
        "authorized_official_telephone_number": "313-342-1997"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Warren, MI
• Providers in Warren, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; 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.