NPIMap

Organization Active NPI

Periodontic PLLC

  • Periodontics
  • Wyandotte, MI
National Provider Identifier
1205014669
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
PERIODONTIC PLLC
Practice address
3589 Fort St
Wyandotte, MI 48192-6315
Phone
(734) 281-1414
NPI assigned
Feb 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

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

Authorized official

Name
Dr. David G Darany, DDS, MSNPI 1164513487
Title
President
Phone
(313) 274-8522

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

3589 Fort St
Wyandotte, MI 48192-6315

Mailing address

22801 Newman St.
Dearborn, MI 48124-1740
Phone (313) 274-8522

National Provider Directory

National Provider Directory
Tax ID family
Periodontic PLLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

24924 Michigan Ave
Dearborn, MI 48124
Phone (313) 274-8522

3589 Fort St
Wyandotte, MI 48192
Phone (274) 281-1414

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363219200000",
    "number": "1205014669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22801 NEWMAN ST.",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241740",
            "telephone_number": "313-274-8522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3589 FORT ST",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481926315",
            "telephone_number": "734-281-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2013-03-14",
        "status": "A",
        "authorized_official_last_name": "DARANY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-274-8522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; 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.