NPIMap

Organization Active NPI

Tru Dental Michigan PC

  • General Practice Dentistry
  • Portland, MI
National Provider Identifier
1770164980
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TRU DENTAL MICHIGAN PC
Practice address
155 Rowe Ave
Portland, MI 48875-1645
Phone
(517) 647-6205
Fax
(517) 647-6205
NPI assigned
Apr 19, 2021
Organization subpart
Yes
Parent organization
TRU DENTAL MICHIGAN PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

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

Addresses

Primary practice location

155 Rowe Ave
Portland, MI 48875-1645

Mailing address

155 Rowe Ave
Portland, MI 48875-1645
Phone (517) 647-6205

Other names 1

  • Tru Family Dental - Portland Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tru Dental Michigan PC10 organizations share this tax ID, including this one
Part of
Tru Dental Michigan PC

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

155 Rowe Ave
Portland, MI 48875
Phone (517) 647-6205

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": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618790400000",
    "number": "1770164980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 ROWE AVE",
            "city": "PORTLAND",
            "state": "MI",
            "postal_code": "488751645",
            "telephone_number": "517-647-6205",
            "fax_number": "517-647-6205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 ROWE AVE",
            "city": "PORTLAND",
            "state": "MI",
            "postal_code": "488751645",
            "telephone_number": "517-647-6205",
            "fax_number": "517-647-6205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRU DENTAL MICHIGAN PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRU DENTAL MICHIGAN PC",
        "enumeration_date": "2021-04-19",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "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": "Tru Family Dental - Portland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; 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.