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PRO DENTAL MI 1 PC
NPI 1457188955
Dentist in Detroit, MI

Active since September 18, 2024
21427 GRAND RIVER AVE STE 100, DETROIT, MI 48219(313) 412-2100(313) 766-7734 Get Directions Write a Review

NPPES record last updated: September 18, 2024. Verified against the NPPES registry weekly; last sync: September 20, 2026.

About Pro Dental Mi 1 Pc NPPES

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

PRO DENTAL MI 1 PC (NPI 1457188955), doing business as Destiny Dental Of Grand River, is a healthcare organization registered as a dentist in Detroit, Michigan and active in the NPI registry since September 2024. The organization lists Simone Wilson-adeleke, Director Of Credentialing, as its authorized official.

NPPES Registry Identity

NPI1457188955
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NamePRO DENTAL MI 1 PC
Location Address21427 GRAND RIVER AVE STE 100Detroit, MI 48219-3897
Mailing Address10 Woodbridge Center Dr Ste 520Woodbridge, NJ 07095-1152 · (732) 914-1422
Phone(313) 412-2100
Fax(313) 766-7734
Organization SubpartNo
Authorized OfficialSimone Wilson-adelekeDirector Of Credentialing · (732) 914-3991
Enumeration DateSeptember 18, 2024
NPPES CertifiedSeptember 18, 2024
✔ NPI 1457188955 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
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.
Also ListedDentist · General PracticeTaxonomy 1223G0001X
21427 GRAND RIVER AVE STE 100, Detroit, MI 48219
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Other Names 1

Doing Business AsDestiny Dental Of Grand River

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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 ›

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 Pro Dental Mi 1 PC's NPI number?

The NPI number for Pro Dental Mi 1 PC is 1457188955. It was assigned to this organization in the NPPES registry on September 18, 2024. The provider is doing business as Destiny Dental of Grand River.

Where is Pro Dental Mi 1 PC located?

Pro Dental Mi 1 PC is located at 21427 Grand River Ave Ste 100, Detroit, MI 48219. The listed phone number is (313) 412-2100.

What is Pro Dental Mi 1 PC's specialty?

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

What insurance does Pro Dental Mi 1 PC accept?

Health plans from Blue Cross Blue Shield of Michigan Mutual Insurance Company list Pro Dental Mi 1 PC 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 Pro Dental Mi 1 PC was last updated on September 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.