Southfield Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

2901014077 Issued in MI

Legal business name

SOUTHFIELD DENTAL PLLC

Practice address

17600 W 12 Mile Rd
Suite 3
Southfield, MI 48076-1910

Phone

(248) 569-6722

Fax

(248) 569-7409

NPI assigned

Mar 12, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Raymond A Fortson Jr., DDS

Title

Member

Phone

(248) 569-6722

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Allor Jr.

  • Dentist
  • Southfield, MI
  • NPI 1366823478
  NPD (past)
• Cory Fortson

  • Oral and Maxillofacial Surgery (Dentist)
  • Southfield, MI
  • NPI 1306258280
  NPD (past)

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

{
    "created_epoch": "1236816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1104067644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17600 W 12 MILE RD",
            "address_2": "SUITE 3",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480761910",
            "telephone_number": "248-569-6722",
            "fax_number": "248-569-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17600 W 12 MILE RD",
            "address_2": "SUITE 3",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480761910",
            "telephone_number": "248-569-6722",
            "fax_number": "248-569-7409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-12",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "FORTSON",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "248-569-6722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901014077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Rehabilitation and Physical Therapy Inc.
• Southfield Center for Intergrated Musculoskeletal Injury PC
• Southfield City Urgent Care PC
• Southfield Dental Care P.C.
• Southfield Dental Center PC
• Southfield Essential Care PLLC
• Southfield Family Dental Center
• Southfield Family Dental Center PLLC
• Southfield Family Foot Center, P.C.
• Southfield Family Physicians, PLLC

• Dentist in Southfield, MI
• Providers in Southfield, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2009; 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.