Organization Active NPI

Fill Good Dental Center PLLC

  • Dentist
  • Detroit, MI
National Provider Identifier
1093266215
Registry record updated Oct 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901017708 Issued in MI
Legal business name
FILL GOOD DENTAL CENTER PLLC
Practice address
18570 Grand River Ave
102
Detroit, MI 48223-2201
Phone
(313) 837-3000
Fax
(313) 838-4581
NPI assigned
Oct 24, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2016

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

Authorized official

Name
Lawrence Stewart, D.D.S.
Title
Doc/Partner
Phone
(313) 837-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2901017708 MI Primary

Addresses

Primary practice location

18570 Grand River Ave
102
Detroit, MI 48223-2201

Mailing address

18750 Grand River Ave
102
Detroit, MI 48223
Phone (313) 837-3000

National Provider Directory

National Provider Directory

Locations

18570 Grand River Ave
Ste 102
Detroit, MI 48223
Phone (313) 646-4681

18750 Grand Riv Ave
102
Detroit, MI 48223

NPI Registry JSON

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477267200000",
    "number": "1093266215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18750 GRAND RIVER AVE",
            "address_2": "102",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48223",
            "telephone_number": "313-837-3000",
            "fax_number": "313-838-4581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18570 GRAND RIVER AVE",
            "address_2": "102",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482232201",
            "telephone_number": "313-837-3000",
            "fax_number": "313-838-4581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FILL GOOD DENTAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2016-10-24",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "DOC/PARTNER",
        "authorized_official_telephone_number": "313-837-3000",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901017708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; 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.