MICHIGAN PERIODONTICS GROUP LLC (NPI# 1578002812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578002812 |
| Entity Type | Organization |
| Organization Name | MICHIGAN PERIODONTICS GROUP LLC |
| Practice Address |
350 N Main St Ste 110 Chelsea MI 48118-1486 |
| Mailing Address |
350 North Main Street Suite 110 Chelsea MI 48118 |
| Practice Telephone | 7347192700 |
| Mailing Telephone | 7347192700 |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2017-02-20 |
| Authorized Official Name | SHAWN MICHAEL ETHERTON (REGIONAL MANAGER) |
| Authorized Official Telephone | 6167806879 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
2901021083 | MI | Dental Providers |
| Street Address |
350 N MAIN ST STE 110 |
| City | CHELSEA |
| State | MI |
| Zip Code | 48118-1486 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689139354 | Timothy Edward Johnson | Behavioral Analyst | 1075 N Main Street, Chelsea, MI 48118 | 2019-02-06 |
| 1548731847 | Daniel Mcnerney | Behavior Technician | 107.5 N Main St, Chelsea Mi 48118, MI 48118 | 2018-12-12 |
| 1285177881 | Marla J Field | Counselor | 350 North Main Street, Thriving Minds Family Service, Chelsea, MI 48118 | 2016-11-30 |
| 1093115032 | Elizabeth Spotts | Social Worker | 350 N Main St Ste 220, Chelsea, MI 48118 | 2014-08-27 |
| 1336553239 | Kylene Willsey | Pediatrics | 13699 E Old Us Highway 12, Chelsea, MI 48118 | 2014-06-18 |
| 1730590985 | Vandan Shah | Dermatology | 14650 E. Old Us 12, Suite 308, Chelsea, MI 48118 | 2014-05-09 |
| 1447695952 | James Herbert Botsford | Family Medicine | 201 E. Cedar Lake Dr., Chelsea, MI 48118 | 2013-05-10 |
| 1972864403 | Caroline Nicole Wolfe Wurtzel | Orthopaedic Surgery | 14650 E Old Us Highway 12 Ste 104, Chelsea, MI 48118 | 2012-05-31 |
| 1396019766 | Markus Koch | Mechanotherapist | 21390 Waterloo Rd, Chlesea, MI 48118 | 2012-03-02 |
| 1023305810 | Denise Renae Rokke | Occupational Therapist | 801 W Middle St, Chelsea, MI 48118 | 2011-06-30 |
| Find all providers in zip 48118 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730102088 | Peter Alan Jezewski | Dentist | 100 Everett Ave, Unit 5, Chelsea, MA 02150 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396352175 | Khaled Sinjab | Dentist | 8641 W Grand River Ave Ste 8, Brighton, MI 48116-4330 | 2020-09-25 |
| 1174134605 | Bay Periodontics | Dentist | 1666 Towsley Ln, Ann Arbor, MI 48105-9336 | 2020-08-10 |
| 1699309500 | Ann Arbor Periodontics | Dentist | 2715 Packard St Ste C, Ann Arbor, MI 48108-3365 | 2020-02-29 |
| 1679044192 | David I Lipton D.d.s., M.s. | Dentist | 50 W Big Beaver Rd Ste 150, Bloomfield Hills, MI 48304-3911 | 2018-12-10 |
| 1326576646 | Thomas James Fleszar | Dentist | 1175 Harrow Cir, Bloomfield Hills, MI 48304-3922 | 2017-05-31 |
| 1386185445 | Khairunnisa Quraishi Dds PC | Dentist | 37184 Dequindre Rd, Sterling Heights, MI 48310-3536 | 2017-03-09 |
| 1518410836 | Mohamed Elazhri | Dentist | 27200 Parkview Blvd Apt 901, Warren, MI 48092-2820 | 2016-08-03 |
| 1316314834 | Whitney Dunn Weiner | Dentist | 2425 E Lincoln St, Suite 100, Birmingham, MI 48009-7100 | 2015-09-01 |
| 1639569684 | Divine Family Denistry | Dentist | 27845 Gratiot Ave, Roseville, MI 48066-4848 | 2015-01-29 |
| 1558604454 | Paul Vanraaphorst D.d.s., M.s., P.C. | Dentist | 441 S. Livernois, Suite 280, Rochester Hills, MI 48044-2592 | 2013-03-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.