Active NPI
Mary Kathryn Such, DDS
- Dentist
- Dearborn Heights, MI
National Provider Identifier
1255487237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901013009
- Practice address
- 20217 Ann Arbor Trail
Dearborn Heights, MI 48127-2692 - Phone
- (313) 982-3720
- Fax
- (313) 982-3723
- NPI assigned
- Jan 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901013009 | MI | Primary |
Addresses
Primary practice location
20217 Ann Arbor Trail
Dearborn Heights, MI 48127-2692
Mailing address
PO Box 131070
Ann Arbor, MI 48113-1070
Phone (313) 982-3720
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3278447 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901013009 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255487237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 131070",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481131070",
"telephone_number": "313-982-3720",
"fax_number": "313-982-3723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20217 ANN ARBOR TRAIL",
"city": "DEARBORN HEIGHTS",
"state": "MI",
"postal_code": "481272692",
"telephone_number": "313-982-3720",
"fax_number": "313-982-3723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUCH",
"first_name": "MARY",
"middle_name": "KATHRYN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901013009",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3278447",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dearborn Heights, MI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.