NPIMap

Organization Active NPI

Premier Dental PC

  • Dentist
  • Dearborn, MI
National Provider Identifier
1366721292
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901020370 Issued in MI
Legal business name
PREMIER DENTAL PC
Practice address
22801 Newman St
Dearborn, MI 48124-2200
Phone
(313) 274-8522
Fax
(313) 274-5396
NPI assigned
Aug 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

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

Authorized official

Name
Pota A Rakes, DDS
Title
Owner
Phone
(402) 981-2996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2901020370 MI Primary

Addresses

Primary practice location

22801 Newman St
Dearborn, MI 48124-2200

Mailing address

22801 Newman St
Dearborn, MI 48124-2200
Phone (313) 274-8522

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1366721292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22801 NEWMAN ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242200",
            "telephone_number": "313-274-8522",
            "fax_number": "313-274-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22801 NEWMAN ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242200",
            "telephone_number": "313-274-8522",
            "fax_number": "313-274-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "RAKES",
        "authorized_official_first_name": "POTA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-981-2996",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.