Organization Active NPI

Preventative Dental PC

  • Dentist
  • Detroit, MI
National Provider Identifier
1619316569
Registry record updated Jun 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PREVENTATIVE DENTAL PC
Practice address
15510 Livernois Ave
Detroit, MI 48238-1343
Phone
(313) 863-2800
NPI assigned
Jun 24, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2013

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

Authorized official

Name
Pamela L Hyde
Title
Office Manager
Phone
(313) 863-2800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X MI Primary

Addresses

Primary practice location

15510 Livernois Ave
Detroit, MI 48238-1343

Mailing address

PO Box 38367
Detroit, MI 48238-0367
Phone (313) 863-2800

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372032000000",
    "number": "1619316569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38367",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482380367",
            "telephone_number": "313-863-2800"
        },
        {
            "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": "313-863-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTATIVE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-24",
        "last_updated": "2013-06-24",
        "status": "A",
        "authorized_official_last_name": "HYDE",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "313-863-2800"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.