Prime Dentistry Lincoln Park

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PRIME DENTISTRY LINCOLN PARK

Practice address

1880 Emmons Blvd
Lincoln Park, MI 48146-3866

Phone

(313) 388-8444

NPI assigned

Feb 7, 2023

Organization subpart

No

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

Authorized official

Name

Jessica Tomes

Title

Operations Director

Phone

(734) 722-1617

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1164128401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24505 FAIRMOUNT DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 EMMONS BLVD",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481463866",
            "telephone_number": "313-388-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME DENTISTRY LINCOLN PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "TOMES",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "734-722-1617"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.