Active NPI
Judith Charlene Archibald, D.D.S.
- General Practice Dentistry
- Houghton, MI
National Provider Identifier
1992848097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 012723
- Practice address
- 1220 Military Rd
Houghton, MI 49931-1986 - Phone
- (906) 482-4262
- Fax
- (906) 482-4356
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 012723 | MI | Primary |
Addresses
Primary practice location
1220 Military Rd
Houghton, MI 49931-1986
Mailing address
1220 Military Rd
Houghton, MI 49931-1986
Phone (906) 482-4262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4061461 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012723 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1992848097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1220 MILITARY RD",
"city": "HOUGHTON",
"state": "MI",
"postal_code": "499311986",
"telephone_number": "906-482-4262",
"fax_number": "906-482-4356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1220 MILITARY RD",
"city": "HOUGHTON",
"state": "MI",
"postal_code": "499311986",
"telephone_number": "906-482-4262",
"fax_number": "906-482-4356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARCHIBALD",
"first_name": "JUDITH",
"middle_name": "CHARLENE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "012723",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4061461",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houghton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.