Old Mission Peninsula Dentistry RC

Primary specialty

DentistTaxonomy code 122300000X

License

2901019846 Issued in MI

Legal business name

OLD MISSION PENINSULA DENTISTRY RC

Doing business as

Old Mission Dentistry

Practice address

3258 Bowers Harbor Rd
Traverse City, MI 49686-9737

Phone

(231) 223-4232

Fax

(231) 223-9205

NPI assigned

Mar 23, 2016

Organization subpart

No

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

Authorized official

Name

Melissa AylworthNPI 1467614115

Title

Owner

Phone

(231) 223-4232

Specialties & licenses 1

Addresses

Other names 1

• Old Mission Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melissa Aylworth, DDS

  • Dentist
  • Traverse City, MI
  • NPI 1467614115
  NPD (past) Authorized official
• Fred Deckert Stoye Jr., D.D.S.

  • General Practice Dentistry
  • Traverse City, MI
  • NPI 1144356692
  NPD (past)

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

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459123200000",
    "number": "1497117923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3258 BOWERS HARBOR RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496869737",
            "telephone_number": "231-223-4232",
            "fax_number": "231-223-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3258 BOWERS HARBOR RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496869737",
            "telephone_number": "231-223-4232",
            "fax_number": "231-223-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MISSION PENINSULA DENTISTRY RC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-23",
        "last_updated": "2016-03-28",
        "status": "A",
        "authorized_official_last_name": "AYLWORTH",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-223-4232"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Mission Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kean T Oh, M.D.
• Kevin James Ohara, LBSW
• Stephen Henry Oklat, PHYSICIAN ASSISTANT
• Old Mission Advanced Care, PLLC
• Old Mission Medicine Wound Care New York PLLC
• Old Mission Wound Care Arizona PLLC
• Old Mission Wound Care Colorado PLLC
• Old Mission Wound Care Florida PLLC
• Old Mission Wound Care Georgia LLC
• Old Mission Wound Care Indiana LLC

• Dentist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2016; 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.