Livernois Dental Care PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LIVERNOIS DENTAL CARE PLLC

Practice address

17170 Livernois Ave
Detroit, MI 48221-3028

Phone

(313) 340-9709

Fax

(313) 397-9245

NPI assigned

May 10, 2019

Last updated

May 10, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Ann Chiselom

Title

Office Manager

Phone

(313) 977-0255

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kais Dardar

  • General Practice Dentistry
  • Sterling Heights, MI
  • NPI 1508476284
  NPD (past)

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

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557446400000",
    "number": "1619533171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17170 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482213028",
            "telephone_number": "313-340-9709",
            "fax_number": "313-397-9245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17170 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482213028",
            "telephone_number": "313-340-9709",
            "fax_number": "313-397-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVERNOIS DENTAL CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-10",
        "last_updated": "2019-05-10",
        "status": "A",
        "authorized_official_last_name": "CHISELOM",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "313-977-0255"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Live Long Home Care
• Lively Residential Paradise
• Lively Residential Paradise (Lively Facilitated Living)
• Santanna Lively
• Shakeita La'Neice Lively, BSW
• Livernois Express Pharmacy
• Livernois Family Medical SVC
• Livernois Family Pharmacy
• Livernois Pharmacy Inc
• Jeanne Ann Livernois, AU.D.

• Dental Clinic/Center in Detroit, MI
• Providers in Detroit, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; 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.