NPIMap

Organization Active NPI

Beacon Dental Center Gaylord

  • General Practice Dentistry
  • Gaylord, MI
National Provider Identifier
1134599251
Registry record updated Oct 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19909 Issued in MI
Legal business name
BEACON DENTAL CENTER GAYLORD
Practice address
1723 W M 32
Building B
Gaylord, MI 49735-9544
Phone
(989) 448-2802
Fax
(231) 547-5077
NPI assigned
Oct 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2015

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

Authorized official

Name
Dr. Michael A Sullivan, DDS
Title
Owner / Doctor
Phone
(231) 547-9141

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 19909 MI Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 13522 MI

Addresses

Primary practice location

1723 W M 32
Building B
Gaylord, MI 49735-9544

Mailing address

6483 M 66 N
Charlevoix, MI 49720-9272
Phone (231) 547-9141

Other names 1

  • Beacon Dental Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1443657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443657600000",
    "number": "1134599251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6483 M 66 N",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497209272",
            "telephone_number": "231-547-9141",
            "fax_number": "231-547-5077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 W M 32",
            "address_2": "BUILDING B",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359544",
            "telephone_number": "989-448-2802",
            "fax_number": "231-547-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON DENTAL CENTER GAYLORD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-01",
        "last_updated": "2015-10-01",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER / DOCTOR",
        "authorized_official_telephone_number": "231-547-9141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "19909",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "13522",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; 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.