Individual provider Active NPI

Logan Breann Schuiteman, DMD

  • Dentist
  • Saginaw, MI
National Provider Identifier
1407348485
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901022636 Issued in MI
Practice address
4685 McLeod Dr E
Saginaw, MI 48604-2851
Phone
(989) 799-5690
NPI assigned
Jun 5, 2018
Last updated
Aug 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1002187-15 WI
General Practice Dentistry 1223G0001X 12079 TN
Dentist 122300000X 2901022636 MI Primary

Addresses

Primary practice location

4685 McLeod Dr E
Saginaw, MI 48604-2851

Mailing address

614 Mabry Hood Rd Ste 201
Knoxville, TN 37932-2669
Phone (865) 675-3773

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180814000395 MI Order and Referring Only - DentistPractitioner - Dentist 1850640558

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1002187-15WIMDGeneral Practice Dentistry
12079TNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ashly Bailey DDS PLC CurrentSince Aug 11, 2024 Accepting new patients

Locations

4685 McLeod Dr E
Saginaw, MI 48604
Phone (989) 799-5690

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723075200000",
    "number": "1407348485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 MABRY HOOD RD STE 201",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379322669",
            "telephone_number": "865-675-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4685 MCLEOD DR E",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042851",
            "telephone_number": "989-799-5690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUITEMAN",
        "first_name": "LOGAN",
        "middle_name": "BREANN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002187-15",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "12079",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901022636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saginaw, MI

Sources for this page

Verify at the official NPI Registry.