Northern Periodontics & Implant Dentistry, P.C.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

2901010159 Issued in MI

Legal business name

NORTHERN PERIODONTICS & IMPLANT DENTISTRY, P.C.

Practice address

2115 M 119
Petoskey, MI 49770-8914

Phone

(231) 347-2518

Fax

(231) 347-8530

NPI assigned

Oct 15, 2012

Last updated

Oct 15, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Vaughn A McGraw, D.D.S., M.S.NPI 1750493896

Title

President

Phone

(231) 347-2518

Specialties & licenses 2

Addresses

Other identifiers 2

Practitioners 3

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.

• Vaughn A McGraw, D.D.S., M.S.

  • Periodontics
  • Petoskey, MI
  • NPI 1750493896
  NPD (past) Authorized official
• Michael R Doctor, D.D.S., M.S.

  • Periodontics
  • Petoskey, MI
  • NPI 1255443321
  NPD (past)
• Bruce D Edwards, DDS

  • Periodontics
  • Petoskey, MI
  • NPI 1639410178
  NPD (past)

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1316299365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 M 119",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708914",
            "telephone_number": "231-347-2518",
            "fax_number": "231-347-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 M 119",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708914",
            "telephone_number": "231-347-2518",
            "fax_number": "231-347-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PERIODONTICS & IMPLANT DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "MCGRAW",
        "authorized_official_first_name": "VAUGHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-347-2518",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "2901010159",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "2901014067",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750493896",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255443321",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northern Michigan Rehabilitation Specialists, P.C.
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• Northern Michigan Sports Medicine Center
• Northern Michigan Urology P.C.
• Northern Pathology Associates, PC
• Northstar Counseling and Herbals LLC
• Northwoods Ear, Nose & Throat PC
• Susan K Nuorala, ANP-C
• Robert J. O'Brien, MSW, LMSW
• Trevor K O'Brien, M.D.,

• Periodontics in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.