Timothy Gerrit Demeulenaere, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901014800 Issued in MI

Practice address

24901 Kelly Rd
Eastpointe, MI 48021-1367

Phone

(586) 772-2090

Fax

(586) 772-0742

NPI assigned

Sep 29, 2006

Sex

Male

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: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386736890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23194 HICKORY CREEK DR",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480425029",
            "telephone_number": "586-598-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24901 KELLY RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480211367",
            "telephone_number": "586-772-2090",
            "fax_number": "586-772-0742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMEULENAERE",
        "first_name": "TIMOTHY",
        "middle_name": "GERRIT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901014800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Davis
• Kyle Douglas Davis
• Flura S. Dawde, M.D.
• Mark L Decco, MD
• Dedicated Physicians Group of Michigan PLLC
• Travis Dennis, LPN
• De'Sha Dent, RBT
• Dental Dreams PLLC
• Dependable Angels
• Detroit Family Center, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.