Active NPI
Priya Banahatti, DMD
- Dentist
- Holland, MI
National Provider Identifier
1801825484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901018573
- Practice address
- 285 James Street
Holland, MI 49424 - Phone
- (616) 738-8978
- Fax
- (616) 738-9127
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901018573 | MI | Primary |
Addresses
Primary practice location
285 James Street
Holland, MI 49424
Mailing address
50 Industrial Park Drive
Bangor, MI 49013
Phone (269) 427-7937
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4554740 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901018573 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311724800000",
"number": "1801825484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 INDUSTRIAL PARK DRIVE",
"city": "BANGOR",
"state": "MI",
"postal_code": "49013",
"telephone_number": "269-427-7937",
"fax_number": "269-427-5180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "285 JAMES STREET",
"city": "HOLLAND",
"state": "MI",
"postal_code": "49424",
"telephone_number": "616-738-8978",
"fax_number": "616-738-9127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANAHATTI",
"first_name": "PRIYA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-03",
"last_updated": "2011-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901018573",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4554740",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.