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FORT STREET DENTISTRY
NPI 1194081273
Dentist - General Practice in Lincoln Park, MI

Active since April 03, 2012
4009 FORT ST, LINCOLN PARK, MI 48146(313) 928-8555(313) 928-1399 Get Directions Write a Review

NPPES record last updated: April 3, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Fort Street Dentistry NPPES

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

FORT STREET DENTISTRY (NPI 1194081273) is a healthcare organization registered as a general practice in Lincoln Park, Michigan and active in the NPI registry since April 2012. The organization lists Shawn M Lavoie, Insurance Biller, as its authorized official.

NPPES Registry Identity

NPI1194081273
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NamePATRICK J KELLY DDS , P.C
Location Address4009 FORT STLincoln Park, MI 48146-4110
Mailing Address4009 Fort StLincoln Park, MI 48146-4110 · (313) 928-8555 · Fax (313) 928-1399
Phone(313) 928-8555
Fax(313) 928-1399
Organization SubpartNo
Authorized OfficialShawn M LavoieInsurance Biller · 31392885555
Enumeration DateApril 3, 2012
✔ NPI 1194081273 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in MI · 2901016290
Definition
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.
4009 FORT ST, Lincoln Park, MI 48146
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Other Names 1

Doing Business AsFort Street Dentistry

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Fort Street Dentistry is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Fort Street Dentistry, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Patrick Kelly, DDS
Dentist
NPI 1629149372
4009 FORT ST
Lincoln Park, MI 48146
(313) 928-8555
✔ PECOSSame address
Pauline Jiddou, D.D.S.
Dentist
NPI 1184812034
18181 W 12 MILE RD SUITE 4
Lathrup Village, MI 48076
(248) 557-5756
✔ PECOS19 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Patrick J Kelly Dds , P.C's NPI number?

The NPI number for Patrick J Kelly Dds , P.C is 1194081273. It was assigned to this organization in the NPPES registry on April 3, 2012. The provider is doing business as Fort Street Dentistry.

Where is Patrick J Kelly Dds , P.C located?

Patrick J Kelly Dds , P.C is located at 4009 Fort St, Lincoln Park, MI 48146. The listed phone number is (313) 928-8555.

What is Patrick J Kelly Dds , P.C's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Patrick J Kelly Dds , P.C enrolled in Medicare?

Yes. Patrick J Kelly Dds , P.C is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Patrick J Kelly Dds , P.C?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dentist, reassign their Medicare billing to Patrick J Kelly Dds , P.C. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Patrick J Kelly Dds , P.C accept?

Health plans from Blue Cross Blue Shield of Michigan Mutual Insurance Company list Patrick J Kelly Dds , P.C as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Patrick J Kelly Dds , P.C was last updated on April 3, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.