Individual provider Active NPI

Laurena Moore Powell, DDS

  • Dentist
  • Detroit, MI
National Provider Identifier
1790901643
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
18029 Issued in MI
Practice address
14356 E Jefferson Ave
Detroit, MI 48215-2932
Phone
(313) 824-9890
Fax
(313) 824-9894
NPI assigned
Apr 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 18029 MI Primary

Addresses

Primary practice location

14356 E Jefferson Ave
Detroit, MI 48215-2932

Mailing address

20103 Rose Fair CT
Katy, TX 77450-5253
Phone (313) 824-9890

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20160202000211 TX Order and Referring Only - DentistPractitioner - Dentist 3577867159

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18029MIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Marty M. Powell DDS PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1790901643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20103 ROSE FAIR CT",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774505253",
            "telephone_number": "313-824-9890",
            "fax_number": "313-824-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14356 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152932",
            "telephone_number": "313-824-9890",
            "fax_number": "313-824-9894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE POWELL",
        "first_name": "LAURENA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2016-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "18029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.