NPIMap

Organization Active NPI

Park Dental Service, P.C.

  • Dental Clinic/Center
  • Detroit, MI
National Provider Identifier
1225584758
Registry record updated Aug 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
13515 Issued in MI
Legal business name
PARK DENTAL SERVICE, P.C.
Practice address
18935 Grand River Ave
Detroit, MI 48223-2273
Phone
(313) 835-8280
Fax
(313) 835-2879
NPI assigned
Aug 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2016

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

Authorized official

Name
Eric Smith, DDSNPI 1922104413
Title
Owner
Phone
(313) 835-8280

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
Dental Clinic/Center 261QD0000X 13515 MI Primary

Addresses

Primary practice location

18935 Grand River Ave
Detroit, MI 48223-2273

Mailing address

18935 Grand River Ave
Detroit, MI 48223-2273
Phone (313) 835-8280

Other identifiers 1

IdentifierTypeStateIssuer
1929970MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1472083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472083200000",
    "number": "1225584758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18935 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482232273",
            "telephone_number": "313-835-8280",
            "fax_number": "313-835-2879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18935 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482232273",
            "telephone_number": "313-835-8280",
            "fax_number": "313-835-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK DENTAL SERVICE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-25",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-835-8280",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": "13515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1929970",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; 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.