Mike Kostakos, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MI-13614 Issued in MI

Practice address

16931 W 10 Mile Rd
Southfield, MI 48075-2919

Phone

(248) 559-1220

Fax

(248) 559-4300

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mike Kostakos, DDS, P.C.

  • Dental Clinic/Center
  • Southfield, MI
  • NPI 1295441822
  NPD

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700932241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16931 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752919",
            "telephone_number": "248-559-1220",
            "fax_number": "248-559-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16931 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752919",
            "telephone_number": "248-559-1220",
            "fax_number": "248-559-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSTAKOS",
        "first_name": "MIKE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "MI-13614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jace Kooiker
• Katherine Koppin
• Russell Koppin, OT
• Samantha Koren, MS
• Mary Kors, RN
• Kyle Koster
• Ayesha Kothari, MD
• Magdalena Agnieszka Kotlarz, PA-C
• Ana Marie Kotsogiannis, CRNA
• Atara Kott

• General Practice Dentistry in Southfield, MI
• Providers in Southfield, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.