NPIMap

Organization Active NPI

Eastside Implants and Periodontics

  • Periodontics
  • Center Line, MI
National Provider Identifier
1932946464
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
EASTSIDE IMPLANTS AND PERIODONTICS
Practice address
25523 Van Dyke Avenue
Center Line, MI 48015
Phone
(586) 757-5454
Fax
(586) 757-4147
NPI assigned
Jul 11, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Kelly Misch, D.D.S., M.S.
Title
Owner/Periodontist
Phone
(734) 975-1743

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

25523 Van Dyke Avenue
Center Line, MI 48015

Mailing address

25523 Van Dyke Avenue
Center Line, MI 48015
Phone (734) 975-1743

National Provider Directory

National Provider Directory
Tax ID family
Eastside Implants and Periodontics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1932946464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25523 VAN DYKE AVENUE",
            "city": "CENTER LINE",
            "state": "MI",
            "postal_code": "48015",
            "telephone_number": "734-975-1743",
            "fax_number": "734-975-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25523 VAN DYKE AVENUE",
            "city": "CENTER LINE",
            "state": "MI",
            "postal_code": "48015",
            "telephone_number": "586-757-5454",
            "fax_number": "586-757-4147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE IMPLANTS AND PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "MISCH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER/PERIODONTIST",
        "authorized_official_telephone_number": "734-975-1743",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Center Line, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.