1. Home
  2. Directory
  3. Michigan
  4. Southfield
  5. Dentist
  6. NPI Profile

SOUTHFIELD DENTAL PLLC
NPI 1104067644
Dentist in Southfield, MI

Active since March 12, 2009
17600 W 12 MILE RD, SUITE 3, SOUTHFIELD, MI 48076(248) 569-6722(248) 569-7409 Get Directions Write a Review

NPPES record last updated: March 12, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southfield Dental Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHFIELD DENTAL PLLC (NPI 1104067644) is a healthcare organization registered as a dentist in Southfield, Michigan and active in the NPI registry since March 2009. The organization lists Raymond A Fortson, Member, as its authorized official.

NPPES Registry Identity

NPI1104067644
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameSOUTHFIELD DENTAL PLLC
Location Address17600 W 12 MILE RD, SUITE 3Southfield, MI 48076-1910
Mailing Address17600 W 12 Mile Rd, Suite 3Southfield, MI 48076-1910 · (248) 569-6722 · Fax (248) 569-7409
Phone(248) 569-6722
Fax(248) 569-7409
Organization SubpartNo
Authorized OfficialRaymond A FortsonMember · (248) 569-6722
Enumeration DateMarch 12, 2009
✔ NPI 1104067644 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MI · 2901014077
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
17600 W 12 MILE RD, Southfield, MI 48076
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JAMES ALLOR JR.
Dentist
17600 W 12 MILE RD, SUITE #3
SOUTHFIELD, MI 48076
Oakland County (248) 569-6722
DR. JAVEN R DURHAM DDS
Dentist
17600 W 12 MILE RD
SOUTHFIELD, MI 48076
Oakland County (248) 569-8770

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southfield Dental PLLC's NPI number?

The NPI number for Southfield Dental PLLC is 1104067644. It was assigned to this organization in the NPPES registry on March 12, 2009.

Where is Southfield Dental PLLC located?

Southfield Dental PLLC is located at 17600 W 12 Mile Rd Suite 3, Southfield, MI 48076. The listed phone number is (248) 569-6722.

What is Southfield Dental PLLC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Southfield Dental PLLC was last updated on March 12, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.