NPIMap

Organization Active NPI

Harbor Dental

  • Dentist
  • Benton Harbor, MI
National Provider Identifier
1992712061
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
HARBOR DENTAL
Practice address
143 E Main
Benton Harbor, MI 49022
Phone
(269) 927-1313
Fax
(269) 934-9447
NPI assigned
Aug 2, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Glenda J Potts, RDA CDA
Title
Office Manager
Phone
(269) 927-1313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

143 E Main
Benton Harbor, MI 49022

Mailing address

143 E Main
Benton Harbor, MI 49022
Phone (269) 927-1313

Other identifiers 1

IdentifierTypeStateIssuer
4545920MedicaidMI

National Provider Directory

National Provider Directory

Locations

143 E Main St
Benton Harbor, MI 49022
Phone (269) 927-1313

Practitioners & affiliated clinicians

Practitioners 5

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": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992712061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 E MAIN",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "49022",
            "telephone_number": "269-927-1313",
            "fax_number": "269-934-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 E MAIN",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "49022",
            "telephone_number": "269-927-1313",
            "fax_number": "269-934-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POTTS",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "269-927-1313",
        "authorized_official_credential": "RDA CDA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4545920",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton Harbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.