NPIMap

Organization Active NPI

Pura Vida Smiles, PC

  • Dentist
  • Jackson, MI
National Provider Identifier
1740602846
Registry record updated Jan 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
15663 Issued in MI
Legal business name
PURA VIDA SMILES, PC
Practice address
1113 Boardman Rd
Jackson, MI 49202-1901
Phone
(517) 768-8100
Fax
(517) 780-0806
NPI assigned
Jan 9, 2014
Last updated
Jan 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2014

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

Authorized official

Name
Jason Bertollini
Title
PRM
Phone
(866) 273-8204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 15663 MI Primary

Addresses

Primary practice location

1113 Boardman Rd
Jackson, MI 49202-1901

Mailing address

PO Box 3189
Syracuse, NY 13220-3189
Phone (866) 273-8204

National Provider Directory

National Provider Directory

Locations

1113 Boardman Rd
Jackson, MI 49202
Phone (248) 345-6820

Practitioners & affiliated clinicians

Practitioners 5

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": "1389225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389225600000",
    "number": "1740602846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132203189",
            "telephone_number": "866-273-8204",
            "fax_number": "866-803-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 BOARDMAN RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492021901",
            "telephone_number": "517-768-8100",
            "fax_number": "517-780-0806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURA VIDA SMILES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-09",
        "last_updated": "2014-01-09",
        "status": "A",
        "authorized_official_last_name": "BERTOLLINI",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRM",
        "authorized_official_telephone_number": "866-273-8204"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "15663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; 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.