Kelly Plaza Dental CT. PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1593854 Issued in MI

Legal business name

KELLY PLAZA DENTAL CT. PC

Practice address

12434 Kelly Rd.
Detroit, MI 48224

Phone

(313) 839-8200

Fax

(313) 839-2772

NPI assigned

Jul 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Wilbert Purifoy, DDS

Title

President

Phone

(313) 839-8200

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770507451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12434 KELLY RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482241518",
            "telephone_number": "313-839-8200",
            "fax_number": "313-839-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12434 KELLY RD.",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48224",
            "telephone_number": "313-839-8200",
            "fax_number": "313-839-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY PLAZA DENTAL CT. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PURIFOY",
        "authorized_official_first_name": "WILBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-839-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "1593854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli Cozy Home Care LLC
• Ethel Kellie-Schellang, LMSW
• Brittni Kellom
• Ja'Keya Kellom, LPC
• Kelly Morang Pharmacy
• Monique Denise Kelly-Perkins
• Conrad Joseph Kelly
• Denise Ann Kelly, LMSW
• James Brian Kelly, M.D
• Jodie Ann Kelly

• General Practice Dentistry in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.