NPIMap

Organization Active NPI

Periodontic PLLC

  • Periodontics
  • Plymouth, MI
National Provider Identifier
1154619583
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
2901015315 Issued in MI
Legal business name
PERIODONTIC PLLC
Practice address
40400 E. Ann Arbor Rd.
Suite 204a
Plymouth, MI 48170
Phone
(734) 459-4077
Fax
(734) 459-4084
NPI assigned
Jul 19, 2011
Last updated
Mar 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

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

Authorized official

Name
Dr. David G Darany, D.D.S., M.S.NPI 1164513487
Title
President
Phone
(248) 851-1034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 2901015315 MI Primary

Addresses

Primary practice location

40400 E. Ann Arbor Rd.
Suite 204a
Plymouth, MI 48170

Mailing address

22801 Newman St.
Dearborn, MI 48124-1740
Phone (313) 274-8522

National Provider Directory

National Provider Directory
Tax ID family
Periodontic PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

40400 Ann Arbor Rd E
Ste 204A
Plymouth, MI 48170
Phone (734) 459-4077

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363219200000",
    "number": "1154619583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22801 NEWMAN ST.",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241740",
            "telephone_number": "313-274-8522",
            "fax_number": "313-274-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40400 E. ANN ARBOR RD.",
            "address_2": "SUITE 204A",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "48170",
            "telephone_number": "734-459-4077",
            "fax_number": "734-459-4084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-19",
        "last_updated": "2013-03-14",
        "status": "A",
        "authorized_official_last_name": "DARANY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-851-1034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "2901015315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; 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.