Ryan Chase Hackenberger, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901602287 Issued in MI

Practice address

19511 Mack Ave
Grosse Pointe Woods, MI 48236-2836

Phone

(313) 882-7152

NPI assigned

Jul 5, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kathleen E. Gibney DDS PC

  • General Practice Dentistry
  • Grosse Pointe Woods, MI
  • NPI 1639277676
  NPD (past)

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

{
    "created_epoch": "1720137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1326884602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 YORKSHIRE RD",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301450",
            "telephone_number": "313-670-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19511 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362836",
            "telephone_number": "313-882-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKENBERGER",
        "first_name": "RYAN",
        "middle_name": "CHASE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-05",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901602287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grosse Pointe Urgent Care PC
• Grosse Pointe Urgent Care PC
• Gail M Grunkemeyer, NP
• Michael J Guest Jr., D.D.S.
• Julie Gutmann, RPH
• Theodore C. Hadgis, D.D.S.
• Hosam Hakim, M.D
• Kaniya Kelis Haley
• Jozie Tonia Hall
• Lakiea Renise Hall

• General Practice Dentistry in Grosse Pointe Woods, MI
• Providers in Grosse Pointe Woods, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.