Southfield Gum Docs, LLC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

21098 Issued in MI

Legal business name

SOUTHFIELD GUM DOCS, LLC

Doing business as

MICHIGAN GUM DOCS

Practice address

18860 W 10 Mile Rd
Southfield, MI 48075-2666

Phone

(248) 327-1919

NPI assigned

Mar 20, 2018

Organization subpart

No

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

Authorized official

Name

Oleg Unpriced Krivichkin, DDS

Title

Doctor

Phone

(248) 327-1919

Specialties & licenses 1

Addresses

Other names 1

• MICHIGAN GUM DOCS Doing business as

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595376000000",
    "number": "1659875144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18860 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752666",
            "telephone_number": "248-327-1919",
            "fax_number": "248-552-0992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18860 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752666",
            "telephone_number": "248-327-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD GUM DOCS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-20",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A",
        "authorized_official_last_name": "KRIVICHKIN",
        "authorized_official_first_name": "OLEG",
        "authorized_official_middle_name": "UNPRICED",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "248-327-1919",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "21098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MICHIGAN GUM DOCS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Periodontics in Southfield, MI
• Providers in Southfield, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; 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.