Individual provider Active NPI

Nikki Moshiri

  • General Practice Dentistry
  • Livonia, MI
National Provider Identifier
1164975520
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901600357 Issued in MI
Practice address
36051 5 Mile Rd
Livonia, MI 48154-1931
Phone
(734) 462-6400
NPI assigned
Aug 2, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901600357 MI Primary
Dentist 122300000X DN22188 FL

Addresses

Primary practice location

36051 5 Mile Rd
Livonia, MI 48154-1931

Mailing address

715 Palm Bay Rd NE Ste 185
West Melbourne, FL 32904-9184
Phone (321) 332-7375

Other practice location 1

715 Palm Bay Rd NE Ste 185
West Melbourne, FL 32904-9184
Phone (321) 332-7375

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN22188FLMDDentist
2901600357MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
David C. Slekovich, D.D.S.,P.C. General Practice PastSince Sep 8, 2024 Accepting new patients
Edp of Mi II PC PastSince Sep 8, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1164975520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 PALM BAY RD NE STE 185",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329049184",
            "telephone_number": "321-332-7375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36051 5 MILE RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541931",
            "telephone_number": "734-462-6400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "715 Palm Bay Rd NE Ste 185",
            "address_purpose": "LOCATION",
            "city": "West Melbourne",
            "state": "FL",
            "postal_code": "329049184",
            "country_code": "US",
            "telephone_number": "321-332-7375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOSHIRI",
        "first_name": "NIKKI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-02",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901600357",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN22188",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.