NPIMap

Organization Active NPI

Professional Dental Alliance of Michigan, LLC

  • Dentist
  • Roseville, MI
National Provider Identifier
1629440581
Registry record updated Oct 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901011201 Issued in MI
Legal business name
PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC
Practice address
25631 Gratiot Ave
Roseville, MI 48066-4434
Phone
(586) 775-3312
Fax
(586) 775-4780
NPI assigned
Oct 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2015

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

Authorized official

Name
Shakib Halabu
Title
Dentist
Phone
(248) 397-1165

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 2901011201 MI Primary

Addresses

Primary practice location

25631 Gratiot Ave
Roseville, MI 48066-4434

Mailing address

11 S Mill St Ste 200
New Castle, PA 16101-3613
Phone (724) 698-2500

Other names 1

  • Dental Care of Michigan, Roseville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Professional Dental Alliance of Michigan LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1446163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446163200000",
    "number": "1629440581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013613",
            "telephone_number": "724-698-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25631 GRATIOT AVE",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664434",
            "telephone_number": "586-775-3312",
            "fax_number": "586-775-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-30",
        "last_updated": "2015-10-30",
        "status": "A",
        "authorized_official_last_name": "HALABU",
        "authorized_official_first_name": "SHAKIB",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "248-397-1165"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901011201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Care of Michigan, Roseville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; 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.