Individual provider Active NPI

Peter Michael Mutch, DDS

  • General Practice Dentistry
  • Lapeer, MI
National Provider Identifier
1780773986
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12141 Issued in MI
Practice address
381 N Saginaw
Lapeer, MI 48446
Phone
(810) 664-4542
Fax
(810) 664-3580
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12141 MI Primary

Addresses

Primary practice location

381 N Saginaw
Lapeer, MI 48446

Mailing address

303 W Newark
Lapeer, MI 48446
Phone (810) 664-4542

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
I20150508001709 MI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6709105927

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12141MIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780773986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 W NEWARK",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "48446",
            "telephone_number": "810-664-4542",
            "fax_number": "810-664-3580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 N SAGINAW",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "48446",
            "telephone_number": "810-664-4542",
            "fax_number": "810-664-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTCH",
        "first_name": "PETER",
        "middle_name": "MICHAEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "12141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lapeer, MI

Sources for this page

Verify at the official NPI Registry.