NPIMap

Organization Active NPI

Holy Family Dental Clinics

  • Dental Clinic/Center
  • Hartford, MI
National Provider Identifier
1164170577
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
HOLY FAMILY DENTAL CLINICS
Doing business as
Holy Family Dental Clinics
Practice address
2 E Main St
Hartford, MI 49057-1120
Phone
(269) 621-0011
Fax
(269) 308-3336
NPI assigned
Mar 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
Dr. Donnie D Bouchard, DO
Title
President
Phone
(269) 621-0011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2 E Main St
Hartford, MI 49057-1120

Mailing address

301 N Center St
Hartford, MI 49057-1199
Phone (269) 621-0011

Other identifiers 1

IdentifierTypeStateIssuer
1164170577MedicaidMI

Other names 1

  • Holy Family Dental Clinics Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Dentrix

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1164170577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 N CENTER ST",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "490571199",
            "telephone_number": "269-621-0011",
            "fax_number": "269-308-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 E MAIN ST",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "490571120",
            "telephone_number": "269-621-0011",
            "fax_number": "269-308-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLY FAMILY DENTAL CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "BOUCHARD",
        "authorized_official_first_name": "DONNIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-621-0011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164170577",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Dentrix",
            "affiliation": "N",
            "address_1": "2 E Main St",
            "city": "Hartford",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490571120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Holy Family Dental Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Holy Family Dental Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hartford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.