Pedo Ortho of Michigan PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PEDO ORTHO OF MICHIGAN PLLC

Practice address

18860 W 10 Mile Rd
Southfield, MI 48075-2666

Phone

(248) 965-4722

NPI assigned

Jan 28, 2022

Organization subpart

No

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

Authorized official

Name

Victoria Johnson

Title

Cro

Phone

(941) 444-0558

Specialties & licenses 1

Addresses

Other names 1

• Dental Care Alliance Other name

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

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1144973371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18860 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18860 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752666",
            "telephone_number": "248-965-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDO ORTHO OF MICHIGAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "941-444-0558"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Care Alliance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ashley Pearson
• Lossie Shevetta Pearson, MA, LPC
• Raven Pearson
• Sailaja Peddireddy, MD
• Pedicenter Associates, P.C.
• Ahmiyah Peete
• Peggy Cheng, M.D., PLLC
• Diamond Keaya Pegues
• Brishek Peguese
• Ronald D Pelavin, M.D.

• 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 Jul 21, 2026; 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.