Mary Ann Harchick, DDSPC

Primary specialty

DentistTaxonomy code 122300000X

License

13752 Issued in MI

Practice address

4204 Pontiac Lake Rd
Waterford, MI 48328

Phone

(248) 682-2050

Fax

(248) 618-3742

NPI assigned

Aug 10, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1316139637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4204 PONTIAC LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "48328",
            "telephone_number": "248-682-2050",
            "fax_number": "248-618-3742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 PONTIAC LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "48328",
            "telephone_number": "248-682-2050",
            "fax_number": "248-618-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARCHICK",
        "first_name": "MARY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDSPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-10",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "13752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12 3053026",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Waterford, MI
• Providers in Waterford, MI by specialty
• Dentist in Michigan

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