Jessica T Phan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901601714 Issued in MI

Practice address

44200 Garfield Rd Ste 100
Clinton Township, MI 48038-1142

Phone

(586) 263-0770

NPI assigned

May 18, 2022

Last updated

Jun 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Mark D. Berman, D.D.S.

  • General Practice Dentistry
  • Clinton Township, MI
  • NPI 1659545580
  NPD (past)

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1811634074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44200 GARFIELD RD STE 100",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381142",
            "telephone_number": "586-263-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44200 GARFIELD RD STE 100",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381142",
            "telephone_number": "586-263-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JESSICA",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-18",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901601714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Claire Petroski, LLMSW
• Jenevieve Peyerk
• Majid Pezhman, MD
• Owen Pfaendtner, MSW, CSW
• Linh Pham, PHARMD
• Annemarie Grace Phemister, DO
• Jena Pickle
• Joseph Piechocki
• Cheyenne Piepmeyer, DO
• Caitlin Pearl Pietila

• Dentist in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.