NPIMap

Organization Active NPI

Adiram Family Dentistry

Doing business as Riverside Family Dental

  • Dentist
  • Mount Clemens, MI
National Provider Identifier
1295113165
Registry record updated Sep 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
ADIRAM FAMILY DENTISTRY
Doing business as
Riverside Family Dental
Practice address
253 S Gratiot Ave
Mount Clemens, MI 48043-2425
Phone
(586) 468-0983
Fax
(586) 468-9661
NPI assigned
May 12, 2015
Last updated
Sep 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2016

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

Authorized official

Name
Dr. Ramakrishna Nallapaneni, DDSNPI 1902167943
Title
Owner
Phone
(586) 468-0983

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

253 S Gratiot Ave
Mount Clemens, MI 48043-2425

Mailing address

253 S Gratiot Ave
Mount Clemens, MI 48043-2425
Phone (586) 468-0983

Other names 1

  • Riverside Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

253 Southbound Gratiot Ave
Mount Clemens, MI 48043
Phone (586) 468-0983

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1431388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475107200000",
    "number": "1295113165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 S GRATIOT AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432425",
            "telephone_number": "586-468-0983",
            "fax_number": "586-468-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 S GRATIOT AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432425",
            "telephone_number": "586-468-0983",
            "fax_number": "586-468-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADIRAM FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-12",
        "last_updated": "2016-09-29",
        "status": "A",
        "authorized_official_last_name": "NALLAPANENI",
        "authorized_official_first_name": "RAMAKRISHNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-468-0983",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Clemens, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.