Active NPI
Ronald F. Konopka, D.D.S.
- General Practice Dentistry
- Detroit, MI
National Provider Identifier
1093847576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10614
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190415001689 | MI | Order and Referring Only - Dentist | 8224379508 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10614 | MI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hillstream Dental of Shores PLLC | General Practice | Past | 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.
-
- General Practice Dentistry
- Saint Clair Shores, MI
- NPI 1619844651
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.