Alexander Athanasios Kakaris Porter, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901600905APP21 Issued in MI

Practice address

21080 Allen Rd
Woodhaven, MI 48183-1602

Phone

(734) 676-1656

NPI assigned

Apr 16, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618531200000",
    "number": "1205417623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26024 HEATHER LN",
            "city": "GROSSE ILE",
            "state": "MI",
            "postal_code": "481381824",
            "telephone_number": "734-353-2068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21080 ALLEN RD",
            "city": "WOODHAVEN",
            "state": "MI",
            "postal_code": "481831602",
            "telephone_number": "734-676-1656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKARIS PORTER",
        "first_name": "ALEXANDER",
        "middle_name": "ATHANASIOS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-16",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901600905APP21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Renee Johnson, RBT
• Lindsay Michelle Johnson, DDS
• Annemarie Jucha
• Anna Lynn Jurado, P.T.
• Kakaris Family Dentistry PC
• Arestea Athanasios Kakaris, DDS
• Anijolta Kambo-Gjelaj, DDS
• Kasey Thomas, Ma, Bcba, LLC
• Olivia Raffaella-Anna Keenan, P.A.-C
• Meredith Keith

• General Practice Dentistry in Woodhaven, MI
• Providers in Woodhaven, 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 Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.