KELLY PLAZA DENTAL CT. PC (NPI# 1770507451) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770507451 |
| Entity Type | Organization |
| Organization Name | KELLY PLAZA DENTAL CT. PC |
| Practice Address |
12434 Kelly Rd. Detroit MI 48224 |
| Mailing Address |
12434 Kelly Rd Detroit MI 48224-1518 |
| Practice Telephone | 3138398200 |
| Practice Fax Number | 3138392772 |
| Mailing Telephone | 3138398200 |
| Mailing Fax Number | 3138392772 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. WILBERT PURIFOY (PRESIDENT) |
| Authorized Official Telephone | 3138398200 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
1593854 | MI | Dental Providers |
| Street Address |
12434 KELLY RD. |
| City | DETROIT |
| State | MI |
| Zip Code | 48224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508403767 | Renia Scott | Licensed Practical Nurse | 5211 Berkshire St, Detroit, MI 48224 | 2019-12-06 |
| 1063928612 | Edith Neely-harris | Registered Nurse | 1203 Courville Street, Detroit, MI 48224 | 2017-12-19 |
| 1043767585 | Annette Jackson | Counselor | 10666 Duprey St, Detroit, MI 48224 | 2016-09-01 |
| 1164977807 | Dehvin White-peck | Technician, Other | 4529 Harvard Rd, Detroit, MI 48224 | 2016-08-23 |
| 1992153704 | Andrea Henderson | Licensed Practical Nurse | 9131 Bradford, Detroit, MI 48224 | 2016-06-02 |
| 1467807578 | Venus Staffing LLC | Nursing Care | 5601 Devonshire Rd, Detroit, MI 48224 | 2016-04-26 |
| 1558795625 | Rafia El-alayli | Internal Medicine | 9901 Whittier Ave, Detroit, MI 48224 | 2013-08-26 |
| 1831334259 | House of Hearts Ministry, Inc. | Voluntary or Charitable | 11151 Worden, Detroit, MI 48224 | 2008-12-15 |
| 1992994636 | Lilian Lai Md PC | Clinic/Center | 15850 E Warren Ave, Detroit, MI 48224 | 2007-10-18 |
| 1184845844 | Tymon C Totte | Dentist | 17700 Mack Ave, Great Expressions Dental Centers, Gross Pointe, MI 48224 | 2007-05-01 |
| Find all providers in zip 48224 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528678687 | Elmwood Park Dental | Dentist | 1547 E Lafayette St, Detroit, MI 48207-2958 | 2020-08-04 |
| 1205452786 | Daniel Galvez | Dentist | 200 Riverfront Dr Apt 20f, Detroit, MI 48226-7598 | 2020-06-22 |
| 1669947107 | Diamond Smiles Dentistry, PC | Dentist | 13334 E Jefferson Ave, Detroit, MI 48215-2719 | 2018-10-11 |
| 1053802629 | Hussein Daher | Dentist | 6061 W Vernor Hwy Ste 1, Detroit, MI 48209-2085 | 2018-05-19 |
| 1497278287 | Kamil Abraham | Dentist | 24366 Grand River Ave Ste 111, Detroit, MI 48219-3098 | 2017-07-24 |
| 1326561887 | Nicholas Dipilla | Dentist | 1 Woodward Ave Ste 1625, Detroit, MI 48226-3422 | 2017-07-17 |
| 1164963401 | Smile Fresh Detroit PC | Dentist | 7230 Gratiot Avenue, Detroit, MI 48213 | 2017-03-20 |
| 1164967469 | Fady Sarkees | Dentist | 21427 Grand River Ave, Detroit, MI 48219-3896 | 2016-12-23 |
| 1538523477 | Charnia Hall | Dentist | 4272 Saint Antoine St, Detroit, MI 48201-2108 | 2016-04-06 |
| 1093178378 | Florence Koloko | Dentist | 250 E Harbortown Dr Apt 608, Detroit, MI 48207-5010 | 2016-04-03 |
| Find all providers in DETROIT | ||||
Please comment or provide details below to improve the information on KELLY PLAZA DENTAL CT. PC.
| 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.