NPIMap

Organization Active NPI

Waterford Kids Dental Club, PLLC

  • General Practice Dentistry
  • Waterford, MI
National Provider Identifier
1689224818
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WATERFORD KIDS DENTAL CLUB, PLLC
Practice address
3801 Elizabeth Lake Rd
Waterford, MI 48328-3017
Phone
(248) 909-2132
NPI assigned
Sep 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Authorized official

Name
Dr. Rebeca Urquiola, DDSNPI 1699802975
Title
Owner
Phone
(248) 909-2132

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3801 Elizabeth Lake Rd
Waterford, MI 48328-3017

Mailing address

4220 Surrey Cross
Bloomfield Hills, MI 48301-1669
Phone (248) 909-2132

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568851200000",
    "number": "1689224818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 SURREY CROSS",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483011669",
            "telephone_number": "248-909-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 ELIZABETH LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283017",
            "telephone_number": "248-909-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD KIDS DENTAL CLUB, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-19",
        "last_updated": "2019-09-19",
        "status": "A",
        "authorized_official_last_name": "URQUIOLA",
        "authorized_official_first_name": "REBECA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-909-2132",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.