NPIMap

Organization Active NPI

Peridontic Associates of Port Huron PLLC

  • Periodontics
  • Port Huron, MI
National Provider Identifier
1760804983
Registry record updated Jan 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
JS019200 Issued in MI
Legal business name
PERIDONTIC ASSOCIATES OF PORT HURON PLLC
Doing business as
Periodontic Associates of Port Huron
Practice address
1175 Thomas Edison Dr
Port Huron, MI 48060-8500
Phone
(810) 987-1400
Fax
(810) 987-1349
NPI assigned
Jan 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2014

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

Authorized official

Name
Dr. Jason George Souyias, D.D.SNPI 1205042785
Title
Partner
Phone
(810) 987-1400

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X JS019200 MI Primary

Addresses

Primary practice location

1175 Thomas Edison Dr
Port Huron, MI 48060-8500

Mailing address

1175 Thomas Edison Dr
Port Huron, MI 48060-8500
Phone (810) 987-1400

Other names 1

  • Periodontic Associates of Port Huron Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1389052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389052800000",
    "number": "1760804983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 THOMAS EDISON DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608500",
            "telephone_number": "810-987-1400",
            "fax_number": "810-987-1349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 THOMAS EDISON DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608500",
            "telephone_number": "810-987-1400",
            "fax_number": "810-987-1349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIDONTIC ASSOCIATES OF PORT HURON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A",
        "authorized_official_last_name": "SOUYIAS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "810-987-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MI",
            "license": "JS019200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Periodontic Associates of Port Huron",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.