NPIMap

Organization Active NPI

Michigan Dental Sleep Center Inc

  • General Practice Dentistry
  • Clio, MI
National Provider Identifier
1376908392
Registry record updated Apr 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MICHIGAN DENTAL SLEEP CENTER INC
Practice address
4279 W Vienna Rd
Clio, MI 48420-9440
Phone
(810) 659-1721
Fax
(810) 659-0897
NPI assigned
Dec 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2022

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

Authorized official

Name
Dr. Chad M Witkow, DDSNPI 1316099179
Title
President
Phone
(810) 659-1721

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

4279 W Vienna Rd
Clio, MI 48420-9440

Mailing address

4279 W Vienna Rd
Clio, MI 48420-9440
Phone (810) 659-1721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160802002606 MI DME Supplier - Oral Surgery - Dentist 1355635103 Practice locations: Clio, MI

National Provider Directory

National Provider Directory
Tax ID family
Michigan Dental Sleep Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

113 E Main St
Flushing, MI 48433
Phone (810) 659-4561

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1376908392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4279 W VIENNA RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484209440",
            "telephone_number": "810-659-1721",
            "fax_number": "810-659-0897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4279 W VIENNA RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484209440",
            "telephone_number": "810-659-1721",
            "fax_number": "810-659-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN DENTAL SLEEP CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-17",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A",
        "authorized_official_last_name": "WITKOW",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-659-1721",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clio, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.