NPIMap

Organization Active NPI

Randa Jundi-Samman DMD & Alister M Mackenzie DDS PC

  • Dentist
  • Port Huron, MI
National Provider Identifier
1083729370
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901016445 Issued in MI
Legal business name
RANDA JUNDI-SAMMAN DMD & ALISTER M MACKENZIE DDS PC
Practice address
1105 Sedgwick St
Port Huron, MI 48060
Phone
(810) 984-2742
Fax
(810) 984-8934
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Randa Jundi-Samman, DMDNPI 1366629479
Title
President Dentist
Phone
(810) 984-2742

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 2901016445 MI Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 2901008328 MI
Dental Clinic/Center 261QD0000X MI

Addresses

Primary practice location

1105 Sedgwick St
Port Huron, MI 48060

Mailing address

1105 Sedgwick St
Port Huron, MI 48060
Phone (810) 984-2742

Other names 1

  • Huron Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1105 Sedgwick St
Port Huron, MI 48060
Phone (810) 984-2742

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": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1083729370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SEDGWICK ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-984-2742",
            "fax_number": "810-984-8934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SEDGWICK ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-984-2742",
            "fax_number": "810-984-8934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDA JUNDI-SAMMAN DMD & ALISTER M MACKENZIE DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JUNDI-SAMMAN",
        "authorized_official_first_name": "RANDA",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "810-984-2742",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901016445",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901008328",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Huron Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.