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EASTSIDE PERIODONTAL ASSOC PLLC
NPI 1144312760
Dentist - Periodontics in Center Line, MI

Active since September 29, 2006
25523 VAN DYKE AVE, CENTER LINE, MI 48015(586) 757-5454(586) 757-4147 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Eastside Periodontal Assoc Pllc NPPES

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

EASTSIDE PERIODONTAL ASSOC PLLC (NPI 1144312760) is a healthcare organization registered as a periodontics in Center Line, Michigan and active in the NPI registry since September 2006. The organization lists Jennifer Lynn Wise, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1144312760
Entity TypeOrganization
Primary Taxonomy1223P0300X
Legal Business NameEASTSIDE PERIODONTAL ASSOC PLLC
Location Address25523 VAN DYKE AVECenter Line, MI 48015-1824
Mailing Address25523 Van Dyke AveCenter Line, MI 48015-1824 · (586) 757-5454 · Fax (586) 757-4147
Phone(586) 757-5454
Fax(586) 757-4147
Organization SubpartNo
Authorized OfficialJennifer Lynn WiseOffice Manager · (586) 757-5454
Enumeration DateSeptember 29, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1144312760 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in MI · B18275
Definition
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.
25523 VAN DYKE AVE, Center Line, MI 48015
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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 3

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

DR. JACK SCHWARCZ D.D.S., M.S.
Dentist (Periodontics)
25523 VAN DYKE AVE
CENTER LINE, MI 48015
Macomb County (586) 757-5454
WALEED RHEBI
Dentist (Periodontics)
25523 VAN DYKE AVE
CENTER LINE, MI 48015
Macomb County (586) 757-5454
EASTSIDE IMPLANTS & PERIODONTICS
Dentist (Periodontics)
25523 VAN DYKE AVE
CENTER LINE, MI 48015
Macomb County (586) 757-5454

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 Eastside Periodontal Assoc PLLC's NPI number?

The NPI number for Eastside Periodontal Assoc PLLC is 1144312760. It was assigned to this organization in the NPPES registry on September 29, 2006.

Where is Eastside Periodontal Assoc PLLC located?

Eastside Periodontal Assoc PLLC is located at 25523 Van Dyke Ave, Center Line, MI 48015. The listed phone number is (586) 757-5454.

What is Eastside Periodontal Assoc PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

When was this NPI record last updated?

The NPPES record for Eastside Periodontal Assoc PLLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.