Michael R Doctor, D.D.S., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

2901014067 Issued in MI

Practice address

2115 M 119
Petoskey, MI 49770-8914

Phone

(231) 347-2518

Fax

(231) 347-8530

NPI assigned

Aug 31, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2005 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Northern Periodontics & Implant Dentistry, P.C.

  • Periodontics
  • Petoskey, MI
  • NPI 1316299365
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255443321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 M 119",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708914",
            "telephone_number": "231-347-2518",
            "fax_number": "231-347-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 M 119",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708914",
            "telephone_number": "231-347-2518",
            "fax_number": "231-347-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOCTOR",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "2901014067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN-MEDICAL",
            "identifier": "5166284",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN-DENTAL",
            "identifier": "D140670",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288090",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Elizabeth Dillinger-Mewbourn
• Christine M Dillon, LPC
• Kristi Lynn Dipzinski, NP-C
• Discover Chiropractic MBS, P.C.
• Docs by the Bay, PLLC
• Andrea Donahoe, LLMSW
• John Patrick Doody, CADC
• Alexander Dennis Doubek, DO
• James A Doull III, M.D.
• Maureen E Doull, M.D.

• Periodontics in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.