NPIMap

Organization Active NPI

Benjamin J Underwood DDS LLC

  • General Practice Dentistry
  • Warren, MI
National Provider Identifier
1710449459
Registry record updated Apr 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BENJAMIN J UNDERWOOD DDS LLC
Doing business as
Village Place Dental
Practice address
6213 Chicago Rd Ste 100
Warren, MI 48092-1697
Phone
(586) 264-5410
Fax
(586) 264-1119
NPI assigned
Apr 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2019

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

Authorized official

Name
Caryn Mallon
Title
Office Manager
Phone
(586) 264-5410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

6213 Chicago Rd Ste 100
Warren, MI 48092-1697

Mailing address

6213 Chicago Rd Ste 100
Warren, MI 48092-1697
Phone (586) 264-5410

Other names 1

  • Village Place Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554163200000",
    "number": "1710449459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6213 CHICAGO RD STE 100",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480921697",
            "telephone_number": "586-264-5410",
            "fax_number": "586-264-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6213 CHICAGO RD STE 100",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480921697",
            "telephone_number": "586-264-5410",
            "fax_number": "586-264-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN J UNDERWOOD DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-04-02",
        "status": "A",
        "authorized_official_last_name": "MALLON",
        "authorized_official_first_name": "CARYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "586-264-5410"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Place Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; 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.