NPIMap

Organization Active NPI

Sault Dental Association

  • General Practice Dentistry
  • Sault Sainte Marie, MI
National Provider Identifier
1114101318
Registry record updated Dec 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901014320 Issued in MI
Legal business name
SAULT DENTAL ASSOCIATION
Practice address
709 Johnston St
Sault Sainte Marie, MI 49783-2335
Phone
(906) 635-6020
Fax
(906) 635-7687
NPI assigned
Dec 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2007

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

Authorized official

Name
Clayton C Shunk, D.D.S.NPI 1093762874
Title
General Partner
Phone
(906) 635-6020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 2901014320 MI Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 2901010627 MI

Addresses

Primary practice location

709 Johnston St
Sault Sainte Marie, MI 49783-2335

Mailing address

709 Johnston St
Sault Sainte Marie, MI 49783
Phone (906) 635-6020

National Provider Directory

National Provider Directory

Locations

709 Johnston St
Sault South Marie, MI 49783
Phone (906) 253-9374

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198454400000",
    "number": "1114101318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 JOHNSTON ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "49783",
            "telephone_number": "906-635-6020",
            "fax_number": "906-635-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 JOHNSTON ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497832335",
            "telephone_number": "906-635-6020",
            "fax_number": "906-635-7687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULT DENTAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-24",
        "last_updated": "2007-12-24",
        "status": "A",
        "authorized_official_last_name": "SHUNK",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "906-635-6020",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014320",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901010627",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sault Sainte Marie, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; 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.