Active NPI
Awesome Dental
- Dentist
- Livonia, MI
National Provider Identifier
1912400128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13751
- Legal business name
- AWESOME DENTAL
- Practice address
- 36000 Five Mile Rd
Livonia, MI 48154-1918 - Phone
- (734) 464-3430
- Fax
- (734) 464-6206
- NPI assigned
- Mar 14, 2018
- Organization subpart
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mark John Halboth
- Title
- DDS
- Phone
- (734) 464-3430
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13751 | MI | Primary |
Addresses
Primary practice location
36000 Five Mile Rd
Livonia, MI 48154-1918
Mailing address
36000 Five Mile Rd
Livonia, MI 48154-1918
National Provider Directory
National Provider Directory- Part of
- Awesome Dental
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520985600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1520985600000",
"number": "1912400128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36000 FIVE MILE RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481541918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36000 FIVE MILE RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481541918",
"telephone_number": "734-464-3430",
"fax_number": "734-464-6206"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AWESOME DENTAL",
"organizational_subpart": "YES",
"enumeration_date": "2018-03-14",
"last_updated": "2018-03-14",
"status": "A",
"authorized_official_last_name": "HALBOTH",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "JOHN",
"authorized_official_title_or_position": "DDS",
"authorized_official_telephone_number": "734-464-3430",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist",
"state": "MI",
"license": "13751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.