Southfield Kids Dentist PLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901020260 Issued in MI

Legal business name

SOUTHFIELD KIDS DENTIST PLC

Practice address

18900 W 10 Mile Rd
Southfield, MI 48075-2669

Phone

(248) 565-3332

NPI assigned

Sep 22, 2016

Last updated

Jan 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ifechide Nwabueze, DMD

Title

Manager

Phone

(248) 217-7997

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1093264731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18900 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752669",
            "telephone_number": "248-565-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18900 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752669",
            "telephone_number": "248-565-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD KIDS DENTIST PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-22",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "NWABUEZE",
        "authorized_official_first_name": "IFECHIDE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "248-217-7997",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901020260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southfield Family Physicians, PLLC
• Southfield Family Practice PLLC
• Southfield Gastroenterology Associates PC
• Southfield Gum Docs, LLC (Michigan Gum Docs)
• Southfield Internists PC
• Southfield Medical Pharmacy Inc (Southfield Medical Pharmacy)
• Southfield Mental Health Associates PC
• Southfield Neurological Assoc PC
• Southfield Obsterical and Gynecologic Institute P.C.
• Southfield Opco LLC (Medilodge of Southfield)

• Pediatric Dentistry in Southfield, MI
• Providers in Southfield, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.