Active NPI
Elisa Dack, RDH
- Dental Hygienist
- West Branch, MI
National Provider Identifier
1508579384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2902012908
- Practice address
- 630 Progress St
West Branch, MI 48661-8603 - Phone
- (989) 345-5020
- NPI assigned
- Dec 27, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902012908 | MI | Primary |
Addresses
Primary practice location
630 Progress St
West Branch, MI 48661-8603
Mailing address
PO Box 806
West Branch, MI 48661-0806
Phone (989) 965-1652
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 |
|---|---|---|---|
| 2902012908 | MI | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672099200000",
"number": "1508579384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 806",
"city": "WEST BRANCH",
"state": "MI",
"postal_code": "486610806",
"telephone_number": "989-965-1652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 PROGRESS ST",
"city": "WEST BRANCH",
"state": "MI",
"postal_code": "486618603",
"telephone_number": "989-345-5020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DACK",
"first_name": "ELISA",
"name_prefix": "Mrs.",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-12-27",
"last_updated": "2022-12-27",
"certification_date": "2022-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MI",
"license": "2902012908",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Branch, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 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.