Jonathon Henning Anderson, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901012981 Issued in MI

Practice address

555 S Old Woodward Ave Ste 777
Birmingham, MI 48009-6618

Phone

(248) 647-4700

Fax

(248) 647-4730

NPI assigned

Nov 16, 2005

Reactivated

Oct 13, 2018

Last updated

Oct 15, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

Univ of Missouri-Kansas City School of Dentistry, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Birmingham Oral & Maxillofacial Surgery, PLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Birmingham, MI
  • NPI 1598255044
  Medicare reassignment NPD

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539561600000",
    "number": "1811979719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 S OLD WOODWARD AVE STE 777",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096618",
            "telephone_number": "248-647-4700",
            "fax_number": "248-647-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S OLD WOODWARD AVE STE 777",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096618",
            "telephone_number": "248-647-4700",
            "fax_number": "248-647-4730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JONATHON",
        "middle_name": "HENNING",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2018-10-15",
        "deactivation_date": "2018-09-24",
        "reactivation_date": "2018-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901012981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4067429",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2990516",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "970F31085",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "JA012981",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda B. Rossi, D.C., LLC
• Amanda Tompkins
• Amazing Physical Therapy and Rehabilitation
• Amyna Ftouni
• Gretchen M Anderson, MSW
• Peter G Anderson, DDS
• Summer Moffat Anderson, PA-C
• Andrea Whedon-Hulbert D.C. PLLC
• Yen Ang, DRPH, MPH, MS, RD, F
• Judith Antenucci, OD

• Oral and Maxillofacial Surgery (Dentist) in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.