Redwood Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

REDWOOD DENTAL GROUP

Practice address

6511 N Canton Center Rd
Canton, MI 48187-1653

Phone

(248) 577-5188

NPI assigned

Oct 14, 2015

Last updated

Oct 14, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark A Bouchillon, D.D.S.

Title

President

Phone

(586) 979-2800

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1164893392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W 13 MILE RD",
            "address_2": "SUITE #100",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480711868",
            "telephone_number": "734-722-5130",
            "fax_number": "734-722-5192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6511 N CANTON CENTER RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481871653",
            "telephone_number": "248-577-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-14",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "BOUCHILLON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "15869792800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Alan Read, DDS
• Tyra Real
• Patricia Reckling, CNP
• Chada Natalie Reddy, MD
• Reena Reddy, MD
• Jennifer Reed, RPH
• Terrance Duane Reed, NP-C
• Reed's Home Health Agency L.L.C
• Tamona Reese
• William Byron Reese Jr., L.L.P.

• General Practice Dentistry in Canton, MI
• Providers in Canton, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; 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.