Active NPI
Jordan Michelle Duarte, DMD
- Pediatric Dentistry
- Southfield, MI
National Provider Identifier
1295358943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2901601273
- Practice address
- 18900 W 10 Mile Rd
Southfield, MI 48075-2669 - Phone
- (248) 565-3332
- NPI assigned
- May 28, 2020
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2901601273 | MI | Primary |
Addresses
Primary practice location
18900 W 10 Mile Rd
Southfield, MI 48075-2669
Mailing address
40470 Capitol Dr
Sterling Heights, MI 48313-5313
Other names 1
- Dr. Jordan Nosis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200616001215 | MI | Order and Referring Only - Other (Physician) | 8921420290 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901601273 | MI | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1590624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668988800000",
"number": "1295358943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40470 CAPITOL DR",
"city": "STERLING HEIGHTS",
"state": "MI",
"postal_code": "483135313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18900 W 10 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480752669",
"telephone_number": "248-565-3332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUARTE",
"first_name": "JORDAN",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-28",
"last_updated": "2022-11-21",
"certification_date": "2022-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MI",
"license": "2901601273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JORDAN",
"last_name": "NOSIS",
"prefix": "DR.",
"credential": "DMD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.