Jayashree Shreeganesh, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901022436 Issued in MI

Practice address

26113 Hoover Rd
Warren, MI 48089-1147

Phone

(586) 393-5686

NPI assigned

Sep 5, 2017

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pro Dental Mi 1 PC

  dba Destiny Dental of Warren

  • General Practice Dentistry
  • Warren, MI
  • NPI 1144057423
  NPD (past)

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1245758820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28547 OAKMONTE CIR E",
            "city": "NEW HUDSON",
            "state": "MI",
            "postal_code": "48165",
            "telephone_number": "718-673-7544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26113 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480891147",
            "telephone_number": "586-393-5686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21427 Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482193896",
            "country_code": "US",
            "telephone_number": "313-412-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHREEGANESH",
        "first_name": "JAYASHREE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-05",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901022436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Charnetta Shufford
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• Yogesh J Shukla, MD
• Siddhi Corp (Rapid Pharmacy)
• Naveed Siddique, MD

• General Practice Dentistry in Warren, MI
• Providers in Warren, 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 Mar 17, 2018; 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.