Andrew James Ekdahl, D.D.S.
Individual provider Active NPI Dentist · Gwinn, MI
NPI 1184983249 · NPPES record last updated May 10, 2012
Key facts
- NPI
- 1184983249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- IN PROCESS (MI)
- Practice address
- 271 E M35
Gwinn, MI 49841-9003 - Phone
- (906) 346-6349
- NPI assigned
- May 10, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150522001804 | MI | Order and Referring Only - Oral Surgery |
1557681012 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IN PROCESS | MI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peninsula Family Dentistry, PC | Dentist | Current | Accepting new patients |
| Gwendolyn Buck DDS PLLC | Past | Accepting new patients | |
| Gwendolyn Buck DDS PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | IN PROCESS | MI | Yes |
Addresses
Primary practice location
271 E M35
Gwinn, MI 49841-9003
Mailing address
727 Kemp St
Lanse, MI 49946-1439
Phone (906) 201-1918
Other providers in Gwinn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.