Active NPI
Brian Joseph Putman, D.D.S.
- Dentist
- Ithaca, MI
National Provider Identifier
1609139302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901021388
- Practice address
- 610 N. Pine River St.
Ithaca, MI 48847 - Phone
- (989) 875-2888
- Fax
- (989) 875-4604
- NPI assigned
- Jun 19, 2012
- Last updated
- Dec 15, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30-023756 | OH | |
| Dentist | 122300000X | 2901021388 | MI | Primary |
Addresses
Primary practice location
610 N. Pine River St.
Ithaca, MI 48847
Mailing address
610 N. Pine River St.
Ithaca, MI 48847
Phone (989) 875-2888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 13, 2015 through Nov 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901021388 | MI | MD | Dentist |
| 30-023756 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Putman Dental PLLC | Dentist | Past | Accepting new patients |
| Pine River Dental Care | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Ithaca, MI
- NPI 1295986479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450137600000",
"number": "1609139302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 N. PINE RIVER ST.",
"city": "ITHACA",
"state": "MI",
"postal_code": "48847",
"telephone_number": "989-875-2888",
"fax_number": "989-875-4604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 N. PINE RIVER ST.",
"city": "ITHACA",
"state": "MI",
"postal_code": "48847",
"telephone_number": "989-875-2888",
"fax_number": "989-875-4604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUTMAN",
"first_name": "BRIAN",
"middle_name": "JOSEPH",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-19",
"last_updated": "2015-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30-023756",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901021388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.