Individual provider Active NPI

Robin George Mohamedally I, DDS

  • General Practice Dentistry
  • Flint, MI
National Provider Identifier
1992216535
Registry record updated Mar 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901022389 Issued in MI
Practice address
3760 S Dort Hwy
Flint, MI 48507-2045
Phone
(810) 820-7766
NPI assigned
Oct 23, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901022389 MI Primary

Addresses

Primary practice location

3760 S Dort Hwy
Flint, MI 48507-2045

Mailing address

3760 S Dort Hwy
Flint, MI 48507-2045
Phone (810) 820-7766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240410002233 MI Order and Referring Only - DentistPractitioner - Dentist 3072951987

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901022389MIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522368000000",
    "number": "1992216535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 S DORT HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485072045",
            "telephone_number": "810-820-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 S DORT HWY",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485072045",
            "telephone_number": "810-820-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHAMEDALLY",
        "first_name": "ROBIN",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-23",
        "last_updated": "2018-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901022389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.