Stephen M Ghezzi, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

2901017960 Issued in MI

Practice address

26018 Pontiac TRL
South Lyon, MI 48178-8050

Phone

(248) 486-4030

Fax

(855) 778-2780

NPI assigned

Aug 30, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tooth Town Pediatric Dentistry, PLLC

  • Dental Clinic/Center
  • South Lyon, MI
  • NPI 1295395739
  NPD (past) Authorized official

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1104819721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26018 PONTIAC TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788050",
            "telephone_number": "248-486-4030",
            "fax_number": "855-778-2780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26018 PONTIAC TRL",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788050",
            "telephone_number": "248-486-4030",
            "fax_number": "855-778-2780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHEZZI",
        "first_name": "STEPHEN",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MI",
            "license": "2901017960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gateway Dental Care, PLC (Gateway Dental Care)
• Generations Family Care
• Genesis Psychological Services, P.C.
• Renee E Geran, D.D.S., M.S.
• Laura Lee Gerwatowski, LLPC
• Valerie E Gilbert
• Carol R Glenn, M.P.T.
• Sharon Goins, P.T.
• Shylaja Gontina-Khatiwala, MD
• Ryan Fielding Grant, PHARM.D.

• Pediatric Dentistry in South Lyon, MI
• Providers in South Lyon, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; 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.