SOUTHFIELD GUM DOCS, LLC (NPI# 1659875144) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659875144 |
| Entity Type | Organization |
| Organization Name | SOUTHFIELD GUM DOCS, LLC |
| Other Organization Name | MICHIGAN GUM DOCS |
| Practice Address |
18860 W 10 Mile Rd Southfield MI 48075-2666 |
| Practice Telephone | 2483271919 |
| Mailing Telephone | 2483271919 |
| Mailing Fax Number | 2485520992 |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2020-07-22 |
| Authorized Official Name | OLEG UNPRICED KRIVICHKIN (DOCTOR) |
| Authorized Official Telephone | 2483271919 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
21098 | MI | Dental Providers |
| Other Name | Type Code |
|---|---|
| MICHIGAN GUM DOCS | Doing Business As Name - Organization |
| Street Address |
18860 W 10 MILE RD |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075-2666 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891942165 | Randall Loren Shaw | Dentist | 18860 W 10 Mile Rd, Southfield, MI 48075-2666 | 2008-08-19 |
| 1528669520 | Sleep Apnea Center | Durable Medical Equipment & Medical Supplies | 18860 W 10 Mile Rd, Southfield, MI 48075-2666 | 2020-11-05 |
| 1235783176 | Salah Aldin Rajab | Dentist | 18860 W 10 Mile Rd, Southfield, MI 48075-2666 | 2019-07-29 |
| 1366950248 | The Best Braces Pllc | Dentist | 18860 W 10 Mile Rd, Southfield, MI 48075-2666 | 2018-01-13 |
| 1093264731 | Southfield Kids Dentist Plc | Dentist | 18860 W 10 Mile Rd, Southfield, MI 48075-2666 | 2016-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| 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 |
|---|---|---|---|---|
| 1003976184 | Donald Boyd Sherman | Dentist | 28365 Tavistock Trl, Southfield, MI 48034-5185 | 2006-12-11 |
| 1023045960 | James E Austin | Dentist | 26211 Central Park, #204, Southfield, MI 48076 | 2006-06-27 |
| 1689043192 | Shelia Y Kennebrew Dds., Ms., PC | Dentist | 29556 Southfield Rd, Suite 100, Southfield, MI 48076-2021 | 2015-09-15 |
| 1801087085 | Joseph Ray Nemeth | Dentist | 29829 Telegraph Rd, Ste 111, Southfield, MI 48034-1330 | 2007-08-05 |
| 1649481755 | Anthony Leron Neely | Dentist | 23077 Greenfield Rd, Suite 285, Southfield, MI 48075-3709 | 2007-05-24 |
| 1114062767 | Joseph R. Nemeth, Dds, PC | Dentist | 29829 Telegraph Rd, Ste 111, Southfield, MI 48034-7655 | 2007-02-21 |
| 1245375724 | Robert Becker | Dentist | 29829 Telegraph Rd, Ste 111, Southfield, MI 48034 | 2007-02-21 |
| 1558465971 | Shelia Yvette Kennebrew Horton | Dentist | 29556 Southfield Rd, Suite 100, Southfield, MI 48076-2021 | 2006-09-08 |
| 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 |
| 1578002812 | Michigan Periodontics Group LLC | Dentist | 350 N Main St Ste 110, Chelsea, MI 48118-1486 | 2017-02-20 |
| 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 |
| Find all providers with the same taxonomy | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
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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.