NPIMap

Organization Active NPI

Northern Michigan Family Dentistry PLLC

Doing business as Cheboygan Family Dentistry

  • Dentist
  • Cheboygan, MI
National Provider Identifier
1437428364
Registry record updated Mar 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
17226 Issued in MI
Legal business name
NORTHERN MICHIGAN FAMILY DENTISTRY PLLC
Doing business as
Cheboygan Family Dentistry
Gaylord Family Dentistry
Practice address
10711 N Straits Hwy
Cheboygan, MI 49721-9077
Phone
(231) 627-9352
Fax
(231) 627-9411
NPI assigned
Dec 21, 2011
Last updated
Mar 19, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHERN MICHIGAN FAMILY DENTISTRY PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2018

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

Authorized official

Name
Nicole Koenig
Title
Office Manager
Phone
(989) 732-4199

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 17226 MI Primary

Addresses

Primary practice location

10711 N Straits Hwy
Cheboygan, MI 49721-9077

Mailing address

PO Box 5215
Cheboygan, MI 49721-5215
Phone (316) 279-3522

Other practice location 1

1507 S Otsego Ave Ste A
Gaylord, MI 49735-9524
Phone (989) 732-4199

Other names 2

  • Cheboygan Family Dentistry Doing business as
  • Gaylord Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northern Michigan Family Dentistry PLLC2 organizations share this tax ID, including this one
Part of
Northern Michigan Family Dentistry PLLC

Other organizations with this tax ID 1

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

Locations

10711 N Straits Hwy
Cheboygan, MI 49721
Phone (231) 627-9352

1507 S Otsego Ave
#A
Gaylord, MI 49735
Phone (989) 732-4199

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521417600000",
    "number": "1437428364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5215",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497215215",
            "telephone_number": "316-279-3522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10711 N STRAITS HWY",
            "city": "CHEBOYGAN",
            "state": "MI",
            "postal_code": "497219077",
            "telephone_number": "231-627-9352",
            "fax_number": "231-627-9411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1507 S Otsego Ave Ste A",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497359524",
            "country_code": "US",
            "telephone_number": "989-732-4199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHERN MICHIGAN FAMILY DENTISTRY PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHERN MICHIGAN FAMILY DENTISTRY PLLC",
        "enumeration_date": "2011-12-21",
        "last_updated": "2018-03-19",
        "status": "A",
        "authorized_official_last_name": "KOENIG",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "989-732-4199"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "17226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cheboygan Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gaylord Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cheboygan, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.