NPIMap

Organization Active NPI

Pine River Dental Care

  • General Practice Dentistry
  • Ithaca, MI
National Provider Identifier
1295986479
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12204 Issued in MI
Legal business name
PINE RIVER DENTAL CARE
Practice address
610 N Pine River St
Ithaca, MI 48847-1167
Phone
(989) 875-2888
Fax
(989) 875-4604
NPI assigned
Oct 6, 2008
Last updated
Aug 21, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Authorized official

Name
Dr. Dale A Nester, DDSNPI 1457401770
Title
Owner
Phone
(989) 875-2888

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12204 MI Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 14779 MI

Addresses

Primary practice location

610 N Pine River St
Ithaca, MI 48847-1167

Mailing address

610 N Pine River St
Ithaca, MI 48847-1167
Phone (989) 875-2888

Other identifiers 1

IdentifierTypeStateIssuer
1519621MedicaidMI

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": "1223251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377043200000",
    "number": "1295986479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "488471167",
            "telephone_number": "989-875-2888",
            "fax_number": "989-875-4604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N PINE RIVER ST",
            "city": "ITHACA",
            "state": "MI",
            "postal_code": "488471167",
            "telephone_number": "989-875-2888",
            "fax_number": "989-875-4604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIVER DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-06",
        "last_updated": "2013-08-21",
        "status": "A",
        "authorized_official_last_name": "NESTER",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-875-2888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "12204",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "14779",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1519621",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; 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.