NPIMap

Organization Active NPI

Edward Street Dental

  • General Practice Dentistry
  • Madison Heights, MI
National Provider Identifier
1700864527
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
17110 Issued in MI
Legal business name
EDWARD STREET DENTAL
Practice address
707 E 12 Mile Rd
Madison Heights, MI 48071-2533
Phone
(248) 548-6110
Fax
(248) 548-2718
NPI assigned
Jan 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kevin M Homer, DDSNPI 1497941967
Title
Owner
Phone
(248) 548-6110

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 13530 MI
General Practice Dentistry 1223G0001X 17110 MI Primary

Addresses

Primary practice location

707 E 12 Mile Rd
Madison Heights, MI 48071-2533

Mailing address

707 E 12 Mile Rd
Madison Heights, MI 48071-2533
Phone (248) 548-6110

National Provider Directory

National Provider Directory

Locations

707 E 12 Mile Rd
Madison Heights, MI 48071
Phone (248) 548-6110

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700864527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E 12 MILE RD",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480712533",
            "telephone_number": "248-548-6110",
            "fax_number": "248-548-2718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E 12 MILE RD",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480712533",
            "telephone_number": "248-548-6110",
            "fax_number": "248-548-2718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD STREET DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOMER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-548-6110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "13530",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "17110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison Heights, MI

Sources for this page

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