Odicare PC

Primary specialty

DentistTaxonomy code 122300000X

License

2901011444 Issued in MI

Legal business name

ODICARE PC

Practice address

15510 Livernois Ave
Detroit, MI 48238-1343

Phone

(313) 863-3800

NPI assigned

Sep 6, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Jerel N Owens, DDS

Title

Responsible Party

Phone

(313) 341-3684

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378425600000",
    "number": "1497180798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27201 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480925127",
            "telephone_number": "586-558-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15510 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482381343",
            "telephone_number": "313-863-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODICARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-06",
        "last_updated": "2013-09-06",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "JEREL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "RESPONSIBLE PARTY",
        "authorized_official_telephone_number": "313-341-3684",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901011444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4718431",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Javier Ochoa, DDS
• Roupen Odabashian, M.D.
• William Oddo, CRNA
• Marquitta Odell
• Yemisi Odetoyinbo, LMSW
• Tanya Odisho, D.O.
• Iesha Odum, MS, CAADC, LPC
• Ama Ofosu-Appiah, DDS
• Kaodichinma Ogbonna
• Doris D Ogburn, RDH

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; 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.