Active NPI
Matthew Robert Dery, DDS
- Dentist
- Bingham Farms, MI
National Provider Identifier
1508386285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901022202
- Practice address
- 24255 W 13 Mile Rd Ste 170
Bingham Farms, MI 48025-4345 - Phone
- (248) 646-2611
- NPI assigned
- Jun 22, 2017
- 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 | 2901022202 | MI | Primary |
Addresses
Primary practice location
24255 W 13 Mile Rd Ste 170
Bingham Farms, MI 48025-4345
Mailing address
565 Haverhill Rd
Bloomfield Hills, MI 48304-3426
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 |
|---|---|---|---|
| 2901022202 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498089600000",
"number": "1508386285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "565 HAVERHILL RD",
"city": "BLOOMFIELD HILLS",
"state": "MI",
"postal_code": "483043426"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24255 W 13 MILE RD STE 170",
"city": "BINGHAM FARMS",
"state": "MI",
"postal_code": "480254345",
"telephone_number": "248-646-2611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERY",
"first_name": "MATTHEW",
"middle_name": "ROBERT",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-22",
"last_updated": "2017-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901022202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bingham Farms, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.