Mike Kostakos, DDS, P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MIKE KOSTAKOS, DDS, P.C.

Doing business as

Southfield Dentistry, P.C.

Practice address

20307 W 12 Mile Rd Ste 101
Southfield, MI 48076-5407

Phone

(248) 559-1220

Fax

(248) 559-4300

NPI assigned

Jan 26, 2023

Organization subpart

No

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

Authorized official

Name

Wala Salama

Title

Office Manager

Phone

(248) 559-1220

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southfield Dentistry, P.C. Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mike Kostakos, D.D.S

  • General Practice Dentistry
  • Southfield, MI
  • NPI 1700932241
  NPD

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

{
    "created_epoch": "1674691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1295441822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20307 W 12 MILE RD STE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480765407",
            "telephone_number": "248-559-1220",
            "fax_number": "248-559-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20307 W 12 MILE RD STE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480765407",
            "telephone_number": "248-559-1220",
            "fax_number": "248-559-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKE KOSTAKOS, DDS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-26",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "SALAMA",
        "authorized_official_first_name": "WALA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "248-559-1220"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700932241",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southfield Dentistry, P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Midwest Infusion Inc
• Midwest Medical Point of Care PC
• Kimberly A Mier, LLPC
• Amanda Mies, LLMSW
• Razvan Dragos Mihalache, PA-C
• Mike Medical Supply Inc
• Mervat Mikhaeil
• Shravani Mikkilineni
• Sara Mikolajczak
• Elizabeth Mae Mikulec, R.D.

• Dental Clinic/Center in Southfield, MI
• Providers in Southfield, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.