General Dentistry Specialists, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901018508 Issued in MI

Legal business name

GENERAL DENTISTRY SPECIALISTS, PC

Practice address

15510 Livernois Ave
Detroit, MI 48238-1343

Phone

(313) 863-2800

Fax

(313) 341-7867

NPI assigned

Nov 25, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Donna Marie Kirchner

Title

Credentialing Manager

Phone

(586) 915-0107

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1659778348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15510 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482381343",
            "telephone_number": "313-863-2800",
            "fax_number": "313-341-7867"
        },
        {
            "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",
            "fax_number": "313-341-7867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERAL DENTISTRY SPECIALISTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-25",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "KIRCHNER",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "586-915-0107",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.