Active NPI
West Grand Dental, PLLC
- Dentist
- Detroit, MI
National Provider Identifier
1689813487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 15814
- Legal business name
- WEST GRAND DENTAL, PLLC
- Practice address
- 2617 W Grand Blvd
Detroit, MI 48208-1234 - Phone
- (313) 875-3440
- Fax
- (313) 875-0521
- NPI assigned
- Feb 18, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Delores Campbell
- Title
- Manager
- Phone
- (313) 407-6291
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 15814 | MI | Primary |
Addresses
Primary practice location
2617 W Grand Blvd
Detroit, MI 48208-1234
Mailing address
2617 W Grand Blvd
Detroit, MI 48208-1234
Phone (313) 875-3440
National Provider Directory
National Provider DirectoryLocations
2617 W Grand Blvd
Detroit, MI 48208
Phone (313) 875-3440
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234915200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1234915200000",
"number": "1689813487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2617 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482081234",
"telephone_number": "313-875-3440",
"fax_number": "313-875-0521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2617 W GRAND BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482081234",
"telephone_number": "313-875-3440",
"fax_number": "313-875-0521"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WEST GRAND DENTAL, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-02-18",
"last_updated": "2009-02-18",
"status": "A",
"authorized_official_last_name": "CAMPBELL",
"authorized_official_first_name": "DELORES",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "313-407-6291",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "MI",
"license": "15814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.