Amanda Marie Desjardins, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901019777 Issued in MI

Practice address

205 Grove St
Mancelona, MI 49659

Phone

(231) 587-5068

NPI assigned

Jun 9, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

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

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.

• Marquette County Health Department Dental Clinic

  • General Practice Dentistry
  • Marquette, MI
  • NPI 1922212901

  General Practice

  NPD (past)

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1336309889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "989 W WASHINGTON ST",
            "address_2": "SUITE 104",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554064",
            "telephone_number": "906-226-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 GROVE ST",
            "city": "MANCELONA",
            "state": "MI",
            "postal_code": "49659",
            "telephone_number": "231-587-5068"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "989 W Washington St",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Marquette",
            "state": "MI",
            "postal_code": "498554064",
            "country_code": "US",
            "telephone_number": "906-226-9992",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DESJARDINS",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-09",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katherine J Ducharme, PA-C
• Richelle Dugyon
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• Kenedy Fomenko, D.M.D
• Patricia Lynn Fuller

• All providers in Mancelona, MI
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.