Individual provider Active NPI

Sophia Elmuradi, B.D.S, MS, DDS

  • Dentist
  • Dearborn, MI
National Provider Identifier
1447669015
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901023146 Issued in MI
Practice address
23157 Michigan Ave
Dearborn, MI 48124-2020
Phone
(313) 561-9500
NPI assigned
Aug 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 390200000X PA
Dentist 122300000X 2901023146 MI Primary

Addresses

Primary practice location

23157 Michigan Ave
Dearborn, MI 48124-2020

Mailing address

23401 Ford Rd
Dearborn, MI 48128-1257
Phone (267) 265-2894

Other practice location 1

2805 N 47th St
510
Philadelphia, PA 19131-1540
Phone (267) 265-2894

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
2901023146MIMDDentist
390200000XPAMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1447669015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23401 FORD RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481281257",
            "telephone_number": "267-265-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23157 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242020",
            "telephone_number": "313-561-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2805 N 47th St",
            "address_2": "510",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191311540",
            "country_code": "US",
            "telephone_number": "267-265-2894",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELMURADI",
        "first_name": "SOPHIA",
        "credential": "B.D.S, MS, DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "390200000X",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901023146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.