NPIMap

Organization Active NPI

Professional Dental Alliance of Michigan, LLC

Doing business as Refresh Dental Center Line

  • Dentist
  • Center Line, MI
National Provider Identifier
1942740337
Registry record updated Mar 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC
Doing business as
Refresh Dental Center Line
Practice address
23845 Van Dyke Ave
Center Line, MI 48015-1300
Phone
(586) 467-0063
NPI assigned
Mar 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2017

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

Authorized official

Name
Maria Jones
Title
Credentialing Specialist
Phone
(724) 698-2132

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

23845 Van Dyke Ave
Center Line, MI 48015-1300

Mailing address

11 S Mill St
Suite 200
New Castle, PA 16101-3613
Phone (724) 698-2500

Other names 1

  • Refresh Dental Center Line Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Professional Dental Alliance of Michigan LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

23845 Van Dyke Ave
Center Line, MI 48015
Phone (586) 467-0063

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1488499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489363200000",
    "number": "1942740337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST",
            "address_2": "SUITE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013613",
            "telephone_number": "724-698-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23845 VAN DYKE AVE",
            "city": "CENTER LINE",
            "state": "MI",
            "postal_code": "480151300",
            "telephone_number": "586-467-0063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-03",
        "last_updated": "2017-03-13",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "724-698-2132"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Refresh Dental Center Line",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 13, 2017; 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.