Active NPI
Kevin M Homer, DDS
- Dentist
- Madison Heights, MI
National Provider Identifier
1497941967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 17110
- Practice address
- 707 E 12 Mile Rd
Madison Heights, MI 48071-2533 - Phone
- (248) 548-6110
- NPI assigned
- Sep 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 17110 | MI | Primary |
Addresses
Primary practice location
707 E 12 Mile Rd
Madison Heights, MI 48071-2533
Mailing address
707 E 12 Mile Rd
Madison Heights, MI 48071-2533
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17110 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edward Street Dental | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Madison Heights, MI
- NPI 1700864527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1497941967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 E 12 MILE RD",
"city": "MADISON HEIGHTS",
"state": "MI",
"postal_code": "480712533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 E 12 MILE RD",
"city": "MADISON HEIGHTS",
"state": "MI",
"postal_code": "480712533",
"telephone_number": "248-548-6110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOMER",
"first_name": "KEVIN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "17110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison Heights, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.