Justin Distelrath

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901023205 Issued in MI

Practice address

1795 W Stadium Blvd
Ann Arbor, MI 48103-5290

Phone

(734) 677-8700

Fax

(734) 839-4137

NPI assigned

Jun 27, 2019

Last updated

Sep 12, 2022By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Ann Arbor Smiles Haddock PLLC

  • Dentist
  • Ann Arbor, MI
  • NPI 1922506674
  NPD
• Apnea Alternatives

  • Dentist
  • Ann Arbor, MI
  • NPI 1881034098
  NPD (past)
• Kennedy Marzonie Gray & Associates PLLC

  • Dentist
  • Ann Arbor, MI
  • NPI 1154430718
  NPD (past)
• Lifetime Dental Care of Michigan, P.C.

  dba Secor Dental Associates

  • General Practice Dentistry
  • Lambertville, MI
  • NPI 1942038880
  NPD (past)
• Secor Dental Associates

  • Dentist
  • Lambertville, MI
  • NPI 1144291832
  NPD (past)

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1881255966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1795 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035290",
            "telephone_number": "734-677-8700",
            "fax_number": "734-839-4137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 W STADIUM BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035290",
            "telephone_number": "734-677-8700",
            "fax_number": "734-839-4137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2365 S Huron Pkwy",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481045156",
            "country_code": "US",
            "telephone_number": "734-677-8700",
            "fax_number": "734-839-4137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DISTELRATH",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-27",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901023205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Direnzo Dental, PLLC
• Kyle Direnzo, DMD
• Mitchell Disharoon, MD
• Roseann Frances Dishman, P.T.
• Carolyn Frances Dishuck, MD
• Christine Dittenber
• Andrew Diuble
• Alexandra Cailyn Diver
• Divine Mercy LLC
• Erin Michelle Diviney Chun, MD

• General Practice Dentistry in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.