NPIMap

Organization Active NPI

Periodontal Specialties

  • Periodontics
  • Sterling Heights, MI
National Provider Identifier
1346428026
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
13303 Issued in MI
Legal business name
PERIODONTAL SPECIALTIES
Practice address
8130 Constitution Blvd
Sterling Heights, MI 48313-3801
Phone
(586) 268-5520
NPI assigned
Feb 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

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

Authorized official

Name
Dr. Jeffery JohnstonNPI 1326058892
Title
President
Phone
(586) 268-5520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 13303 MI Primary

Addresses

Primary practice location

8130 Constitution Blvd
Sterling Heights, MI 48313-3801

Mailing address

8130 Constitution Blvd
Sterling Heights, MI 48313-3801
Phone (586) 268-5520

National Provider Directory

National Provider Directory

Locations

8130 Constitution Blvd
Sterling Hts, MI 48313
Phone (586) 268-1420

Practitioners & affiliated clinicians

Practitioners 1

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": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1346428026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8130 CONSTITUTION BLVD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483133801",
            "telephone_number": "586-268-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8130 CONSTITUTION BLVD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483133801",
            "telephone_number": "586-268-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL SPECIALTIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-05",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-268-5520",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "13303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; 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.