Beacon Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19909 Issued in MI

Legal business name

BEACON DENTAL CENTER

Practice address

6483 M 66 N
Charlevoix, MI 49720-9272

Phone

(231) 547-9141

Fax

(231) 547-5077

NPI assigned

Sep 21, 2015

Last updated

Sep 21, 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. Michael A Sullivan, DDS

Title

Owner / Doctor

Phone

(231) 547-9141

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442793600000",
    "number": "1205205267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6483 M 66 N",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497209272",
            "telephone_number": "231-547-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6483 M 66 N",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497209272",
            "telephone_number": "231-547-9141",
            "fax_number": "231-547-5077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2015-09-21",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER / DOCTOR",
        "authorized_official_telephone_number": "231-547-9141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "13522",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "19909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jay E Balasz, DDS
• Matthew David Batdorff
• Tiffany Ann Baxter, ATC, RT(R), CMT
• Bay Area Substance Education Services (Bases)
• Bay Street Orthopaedics PLLC
• Joelle M Beaudoin, ATC
• Annette Renee Beer, LMSW
• Wallanda W Berarducci
• Bergmann Center, Inc
• Bailey Birdsall, RD

• General Practice Dentistry in Charlevoix, MI
• Providers in Charlevoix, 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 Sep 21, 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.