NPIMap

Organization Active NPI

Prosthodontic & Implant Consultants PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • West Bloomfield, MI
National Provider Identifier
1972794352
Registry record updated May 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
2901010565 Issued in MI
Legal business name
PROSTHODONTIC & IMPLANT CONSULTANTS PC
Practice address
6177 Orchard Lake Road
Suite #120
West Bloomfield, MI 48322
Phone
(248) 855-6655
Fax
(248) 855-0803
NPI assigned
Aug 9, 2007
Last updated
May 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2017

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

Authorized official

Name
Jonathan P. Weins, DDS, MSD
Title
Owner
Phone
(248) 855-6655

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X 2901010565 MI Primary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193200000X MULTI-SPECIALTY GROUP 204E00000X 2901010587 MI

Addresses

Primary practice location

6177 Orchard Lake Road
Suite #120
West Bloomfield, MI 48322

Mailing address

6177 Orchard Lake Road
Suite #120
West Bloomfield, MI 48322
Phone (248) 855-6655

Other identifiers 2

IdentifierTypeStateIssuer
2758821MedicaidMI
3239144MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494547200000",
    "number": "1972794352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6177 ORCHARD LAKE ROAD",
            "address_2": "SUITE #120",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "48322",
            "telephone_number": "248-855-6655",
            "fax_number": "248-855-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6177 ORCHARD LAKE ROAD",
            "address_2": "SUITE #120",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "48322",
            "telephone_number": "248-855-6655",
            "fax_number": "248-855-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSTHODONTIC & IMPLANT CONSULTANTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2017-05-12",
        "status": "A",
        "authorized_official_last_name": "WEINS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-855-6655",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MI",
            "license": "2901010565",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MI",
            "license": "2901010587",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2758821",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3239144",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bloomfield, MI

Sources for this page

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