Bubble Gum Kids Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

BUBBLE GUM KIDS DENTISTRY

Doing business as

Bubble Gum Kids Dentistry

Practice address

15401 Dix Toledo Rd
Southgate, MI 48195

Phone

(734) 999-9292

Fax

(734) 999-9393

NPI assigned

Jun 26, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Amy Paundlay

Title

Sr. Vice President of Operatopms

Phone

(203) 400-9999

Specialties & licenses 1

Addresses

Other names 1

• Bubble Gum Kids Dentistry Doing business as

Locations

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1790461630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15401 DIX TOLEDO RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "48195",
            "telephone_number": "734-999-9292",
            "fax_number": "734-999-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15401 DIX TOLEDO RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "48195",
            "telephone_number": "734-999-9292",
            "fax_number": "734-999-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUBBLE GUM KIDS DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "PAUNDLAY",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT OF OPERATOPMS",
        "authorized_official_telephone_number": "203-400-9999",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bubble Gum Kids Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Christopher Brown
• Robin Brown
• Semaj Brown
• Yolanda Bruce, LPC
• Nicole Marie Bryant, LPC
• William Buck
• Ayla Buckley
• Catherine Buhnerkemper
• Christopher James Burgess
• Shavonn N Burgess, M.A., LPC

• Pediatric Dentistry in Southgate, MI
• Providers in Southgate, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; 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.