Michigan Private Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15810 Issued in MI

Legal business name

MICHIGAN PRIVATE DENTAL GROUP

Practice address

27731 Jefferson Ave
Saint Clair Shores, MI 48081-1309

Phone

(586) 771-6440

Fax

(586) 771-8877

NPI assigned

Dec 2, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Anthony R Bielkie, DDS

Title

President

Phone

(586) 771-3440

Specialties & licenses 2

Addresses

Other names 1

• Stoneridge Dental Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicholas Peter Bielkie, DDS

  • General Practice Dentistry
  • Shelby Township, MI
  • NPI 1821834821

  General Practice

  NPD (past)
• Neil C Manczak, D.D.S.

  • General Practice Dentistry
  • Lansing, MI
  • NPI 1497700991

  General Practice

  NPD (past)

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

{
    "created_epoch": "1417478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1902203227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27731 JEFFERSON AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811309",
            "telephone_number": "586-771-6440",
            "fax_number": "586-771-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27731 JEFFERSON AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811309",
            "telephone_number": "586-771-6440",
            "fax_number": "586-771-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN PRIVATE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-02",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "BIELKIE",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-771-3440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "15810",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "19241",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stoneridge Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michigan Institute of Urology Laboratory
• Michigan Institute of Urology PC
• Michigan Neurology Associates DME
• Michigan Neurology Associates Opt
• Michigan Neurology Associates PC
• Michigan Psychological, P.C.
• Michigan Share Corporation
• John Joseph Migliazzo, DC
• Tihomir B Mihaylov, MD
• Nokaleta Mikel, LLMSW

• General Practice Dentistry in Saint Clair Shores, MI
• Providers in Saint Clair Shores, 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 Dec 2, 2014; 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.