Eastland Dental Center

Primary specialty

DentistTaxonomy code 122300000X

License

17767 Issued in MI

Legal business name

EASTLAND DENTAL CENTER

Practice address

18000 Vernier
Harper Woods, MI 48225

Phone

(313) 521-2070

Fax

(313) 526-9907

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Gianfranco Tiberia, DDS

Title

Owner

Phone

(313) 521-2070

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790845964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 VERNIER",
            "city": "HARPER WOODS",
            "state": "MI",
            "postal_code": "48225",
            "telephone_number": "313-521-2070",
            "fax_number": "313-526-9907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18000 VERNIER",
            "city": "HARPER WOODS",
            "state": "MI",
            "postal_code": "48225",
            "telephone_number": "313-521-2070",
            "fax_number": "313-526-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAND DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TIBERIA",
        "authorized_official_first_name": "GIANFRANCO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-521-2070",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "17767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4274738",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.