NPIMap

Organization Active NPI

Endodontic Associates of Michigan PLLC

  • Endodontics
  • Clarkston, MI
National Provider Identifier
1154496818
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
9345 Issued in MI
Legal business name
ENDODONTIC ASSOCIATES OF MICHIGAN PLLC
Practice address
5825 S. Main Street
Ste. 103
Clarkston, MI 48346
Phone
(248) 620-0002
Fax
(248) 620-0025
NPI assigned
Nov 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Authorized official

Name
Dr. Gerald C Dietz Jr., DDS
Title
Partner Doctor
Phone
(248) 647-7930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X 9345 MI Primary

Addresses

Primary practice location

5825 S. Main Street
Ste. 103
Clarkston, MI 48346

Mailing address

5825 S. Main Street
Ste. 103
Clarkston, MI 48346
Phone (248) 620-0002

Other names 1

  • Endodontic Associates Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Endodontic Associates9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5825 S Main St
Ste 103
Clarkston, MI 48346
Phone (248) 620-8980

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743638400000",
    "number": "1154496818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5825 S. MAIN STREET",
            "address_2": "STE. 103",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "48346",
            "telephone_number": "248-620-0002",
            "fax_number": "248-620-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5825 S. MAIN STREET",
            "address_2": "STE. 103",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "48346",
            "telephone_number": "248-620-0002",
            "fax_number": "248-620-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDODONTIC ASSOCIATES OF MICHIGAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2025-04-03",
        "status": "A",
        "authorized_official_last_name": "DIETZ",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER DOCTOR",
        "authorized_official_telephone_number": "248-647-7930",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MI",
            "license": "9345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endodontic Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clarkston, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; 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.