NPIMap

Organization Active NPI

Fda PC

Doing business as Fenton Dental Associates

  • Dentist
  • Fenton, MI
National Provider Identifier
1295805026
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901017712 Issued in MI
Legal business name
FDA PC
Doing business as
Fenton Dental Associates
Practice address
1535 N Leroy
F
Fenton, MI 48430
Phone
(810) 629-5454
Fax
(810) 629-8932
NPI assigned
Nov 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Julie Kathleen Lezotte
Title
Owner
Phone
(810) 629-5454

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901017712 MI Primary

Addresses

Primary practice location

1535 N Leroy
F
Fenton, MI 48430

Mailing address

1535 N Leroy
F
Fenton, MI 48430
Phone (810) 629-5454

Other names 1

  • Fenton Dental Associates Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295805026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 N LEROY",
            "address_2": "F",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "48430",
            "telephone_number": "810-629-5454",
            "fax_number": "810-629-8932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1535 N LEROY",
            "address_2": "F",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "48430",
            "telephone_number": "810-629-5454",
            "fax_number": "810-629-8932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FDA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEZOTTE",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "KATHLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-629-5454",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901017712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fenton Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.