Active NPI
Nader Naguib
- Periodontics
- Detroit, MI
National Provider Identifier
1699389015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 2901601899
- Practice address
- 2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576 - Phone
- (313) 494-6700
- NPI assigned
- Sep 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DL14982 | MA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Periodontics | 1223P0300X | 2901601899 | MI | Primary |
Addresses
Primary practice location
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Mailing address
2700 Martin Luther King Jr Blvd
Detroit, MI 48208-2576
Other practice location 1
1 Kneeland St
Boston, MA 02111-1527
Phone (617) 636-6888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210429001938 | MA | Order and Referring Only - Dentist | 8628487873 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL14982 | MA | MD | Periodontist |
| 2901601899 | MI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693267200000",
"number": "1699389015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 MARTIN LUTHER KING JR BLVD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482082576",
"telephone_number": "313-494-6700"
}
],
"practiceLocations": [
{
"address_1": "1 Kneeland St",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021111527",
"country_code": "US",
"telephone_number": "617-636-6888",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NAGUIB",
"first_name": "NADER",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-02",
"last_updated": "2023-08-29",
"certification_date": "2023-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MA",
"license": "DL14982",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MI",
"license": "2901601899",
"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 Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.