Individual provider Active NPI

Tamara Rabban Kasmikha, DDS

  • Dentist
  • West Bloomfield, MI
National Provider Identifier
1760841209
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901021779 Issued in MI
Practice address
4852 Lenomar CT
West Bloomfield, MI 48322-2280
Phone
(248) 227-9239
NPI assigned
Feb 11, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901021779 MI Primary

Addresses

Primary practice location

4852 Lenomar CT
West Bloomfield, MI 48322-2280

Mailing address

4852 Lenomar CT
West Bloomfield, MI 48322-2280
Phone (248) 227-9239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190502001378 MI Practitioner - Dentist 6709165723 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901021779MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Alrais MD PC CurrentSince Apr 1, 2019 Accepting new patients
Michael G. Taylor,M.D.P.L.C. PastSince Aug 31, 1999 Accepting new patients

Locations

22646 E 9 Mile Rd
Ste C
Saint Clair Shores, MI 48080
Phone (586) 443-5400

21600 Harper Ave
Ste 100
St Clr Shores, MI 48080
Phone (586) 498-4800

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1455148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1760841209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4852 LENOMAR CT",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483222280",
            "telephone_number": "248-227-9239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4852 LENOMAR CT",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483222280",
            "telephone_number": "248-227-9239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASMIKHA",
        "first_name": "TAMARA",
        "middle_name": "RABBAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-11",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bloomfield, MI

Sources for this page

Verify at the official NPI Registry.