Active NPI
Dental Choice Mobile Dentistry, PLLC
- Dentist
- Canton, MI
National Provider Identifier
1700207669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901011776
- Legal business name
- DENTAL CHOICE MOBILE DENTISTRY, PLLC
- Practice address
- 634 Princess Dr
Canton, MI 48188-1144 - Phone
- (734) 788-8061
- NPI assigned
- Dec 19, 2013
- 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
- Gloria Johnson
- Title
- Manager
- Phone
- (313) 790-0094
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901011776 | MI | Primary |
Addresses
Primary practice location
634 Princess Dr
Canton, MI 48188-1144
Mailing address
PO Box 37047
Oak Park, MI 48237-0047
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387411200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1387411200000",
"number": "1700207669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 37047",
"city": "OAK PARK",
"state": "MI",
"postal_code": "482370047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "634 PRINCESS DR",
"city": "CANTON",
"state": "MI",
"postal_code": "481881144",
"telephone_number": "734-788-8061"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DENTAL CHOICE MOBILE DENTISTRY, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-12-19",
"last_updated": "2013-12-19",
"status": "A",
"authorized_official_last_name": "JOHNSON",
"authorized_official_first_name": "GLORIA",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "313-790-0094"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "MI",
"license": "2901011776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.