Provident Dentistry

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PROVIDENT DENTISTRY

Practice address

40105 Grand River Ave
Suite 1
Novi, MI 48375-2170

Phone

(248) 471-0345

Fax

(248) 471-0671

NPI assigned

Jul 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Alan Jeffrey Kessler, D.D.S.

Title

Secretary

Phone

(248) 471-0345

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216771200000",
    "number": "1407887656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40105 GRAND RIVER AVE",
            "address_2": "SUITE 1",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752170",
            "telephone_number": "248-471-0345",
            "fax_number": "248-471-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40105 GRAND RIVER AVE",
            "address_2": "SUITE 1",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752170",
            "telephone_number": "248-471-0345",
            "fax_number": "248-471-0671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENT DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-07-23",
        "status": "A",
        "authorized_official_last_name": "KESSLER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "248-471-0345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12 2753487",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denise Patricia Provencher, PA-C
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• Tameka Pryor
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• Angela Pucciarelli

• Dentist in Novi, MI
• Providers in Novi, MI by specialty
• Dentist in Michigan

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