Active NPI
Bruce D Edwards, DDS
- Periodontics
- Petoskey, MI
National Provider Identifier
1639410178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2901020869
- Practice address
- 2115 M-119
Petoskey, MI 49770 - Phone
- (231) 347-2518
- Fax
- (231) 347-8530
- NPI assigned
- Mar 8, 2013
- Last updated
- Dec 15, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901020869 | MI | |
| Periodontics | 1223P0300X | 2901020869 | MI | Primary |
Addresses
Primary practice location
2115 M-119
Petoskey, MI 49770
Mailing address
2115 M-119
Petoskey, MI 49770
Phone (231) 347-2518
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 |
|---|---|---|---|
| 2901020869 | MI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Periodontics & Implant Dentistry, P.C. | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Periodontics
- Petoskey, MI
- NPI 1316299365
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513296000000",
"number": "1639410178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2115 M-119",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "49770",
"telephone_number": "231-347-2518",
"fax_number": "231-347-8530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2115 M-119",
"city": "PETOSKEY",
"state": "MI",
"postal_code": "49770",
"telephone_number": "231-347-2518",
"fax_number": "231-347-8530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "BRUCE",
"middle_name": "D",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-08",
"last_updated": "2017-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901020869",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "2901020869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petoskey, MI
- Donald Scott Eaton, D.D.S.
- Dawn Ebersole, FNP-BC
- Ecs Northern Michigan PC
- Joseph Gordon Edelson, MD
- Lance Edgerton, FNP-C
- James Francis Ehrnst, D.C.
- Elevate Medical Spa LLC (Elevate Medical Aesthetics and Wellness)
- Elite Movement Chiropractic Clinic PLC
- Amy-Lynn Ruth Ellenberger, LMT
- Monica Lorraine Elliott
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.