Individual provider Active NPI

Ronald F. Konopka, D.D.S.

  • General Practice Dentistry
  • Detroit, MI
National Provider Identifier
1093847576
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10614 Issued in MI
Practice address
5716 Michigan Ave
Detroit, MI 48210-3039
Phone
(313) 554-3880
Fax
(313) 899-3550
NPI assigned
Mar 11, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901010614 MI
General Practice Dentistry 1223G0001X 10614 MI Primary

Addresses

Primary practice location

5716 Michigan Ave
Detroit, MI 48210-3039

Mailing address

559 W Grand Blvd
Detroit, MI 48216-2200

Other practice location 1

31850 Harper Ave
Saint Clair Shores, MI 48082-1459
Phone (586) 296-1140

Other practice location 2

1700 Waterman St
Detroit, MI 48209-2022
Phone (313) 355-4301

Other practice location 3

20901 Moross Rd
Detroit, MI 48236-2058
Phone (313) 626-2620

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
I20190415001689 MI Order and Referring Only - DentistPractitioner - Dentist 8224379508

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10614MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Hillstream Dental of Shores PLLC General Practice PastSince Nov 7, 2025 Accepting new patients

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": "1173571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1093847576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482162200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5716 MICHIGAN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482103039",
            "telephone_number": "313-554-3880",
            "fax_number": "313-899-3550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31850 Harper Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480821459",
            "country_code": "US",
            "telephone_number": "586-296-1140",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1700 Waterman St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482092022",
            "country_code": "US",
            "telephone_number": "313-355-4301",
            "fax_number": "313-554-1918",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20901 Moross Rd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482362058",
            "country_code": "US",
            "telephone_number": "313-626-2620",
            "fax_number": "313-649-2195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONOPKA",
        "first_name": "RONALD",
        "middle_name": "F.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-11",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901010614",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "10614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.