Active NPI
Eastland Family Dentistry
- General Practice Dentistry
- Detroit, MI
National Provider Identifier
1285880872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 16598
- Legal business name
- EASTLAND FAMILY DENTISTRY
- Practice address
- 16068 E 8 Mile Rd
Detroit, MI 48205-1416 - Phone
- (313) 372-8580
- Fax
- (313) 372-7739
- NPI assigned
- Aug 14, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Fadi G Keyorkgy, D.D.S., M.S.D.
- Title
- Ceo
- Phone
- (313) 372-8580
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) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 16598 | MI | Primary |
Addresses
Primary practice location
16068 E 8 Mile Rd
Detroit, MI 48205-1416
Mailing address
16068 E 8 Mile Rd
Detroit, MI 48205-1416
Phone (313) 372-8580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3369505 | Medicaid | MI |
National Provider Directory
National Provider Directory- Tax ID family
- Eastland Family Dentistry
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Dentistry
- Shelby Township, MI
- NPI 1649595232
Locations
16068 E 8 Mile Rd
Detroit, MI 48205
Phone (313) 372-8580
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Detroit, MI
- NPI 1508908492
-
- Dentist
- Detroit, MI
- NPI 1922291400
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218672000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1218672000000",
"number": "1285880872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16068 E 8 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482051416",
"telephone_number": "313-372-8580",
"fax_number": "313-372-7739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16068 E 8 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482051416",
"telephone_number": "313-372-8580",
"fax_number": "313-372-7739"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EASTLAND FAMILY DENTISTRY",
"organizational_subpart": "NO",
"enumeration_date": "2008-08-14",
"last_updated": "2008-08-14",
"status": "A",
"authorized_official_last_name": "KEYORKGY",
"authorized_official_first_name": "FADI",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "313-372-8580",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "D.D.S., M.S.D."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "16598",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3369505",
"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 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.